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pdfAttachment 3b - Sample Adult Core
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Identification and Verification
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.005
Variable Name
SADULT
Universe
HHSTAT4 = 'S' and (ASTAT = empty or ASTAT = '2')
Universe-text
This is the Sample Adult and (the Sample Adult section has not been started or
completed).
Question Text
* The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be
answered by this person. Probe as necessary to determine the availability of [fill:
ALIAS of Sample Adult].
* If refused enter CTRL-R
Answer Codes
1. Available
2. Not Available
3. Physical or Mental condition prohibits responding
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Sample Adult Available
Fill Instructions
Special Instructions Do not allow "Don't Know" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '1' is entered, display 'Available'; if 'Refused' is
entered, display 'Refused'.
Skip Instructions
<1> if Sample Adult = demographics.hhc.RELRESP_A
[goto beginning of adult.asd]
elseif Sample Adult = demographics.hhc.HHRESP
[goto beginning of adult.asd]
else
[goto AIDVERF_S]
endif
<2> [goto callbk.ACALLBK1]
<3> [goto PROX1]
store '4' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.010
Variable Name
PROX1
Universe
=1
Universe-text
The Sample Adult's physical or mental condition prohibits responding.
Question Text
* Proxy interviews can be done for sample adults that have a mental or physical
condition that
prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: ALIAS of Sample
Adult]'s health available?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Proxy Available
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '2' is entered, display 'No'.
Skip Instructions
<1> [goto PROX2]
<2> [goto PROX3]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.015
Variable Name
PROX2
Universe
PROX1 = '1'
Universe-text
Knowledgeable proxy is available.
Question Text
* Ask if necessary.
What is this person's relationship to [fill: ALIAS of Sample Adult]?
Answer Codes
1. Relative who lives in household
2. Relative who doesn't live in household
3. Other caregiver
4. Other
Question Type
Pick One - answer list pane
Field Pane Description
Proxy's Relationship to Sample Adult
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Skip Instructions
<1-4> [goto AIDVERF_S]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.020
Variable Name
PROX3
Universe
PROX1 = '2'
Universe-text
Knowledgeable proxy is not available.
Question Text
*Ask if necessary.
Can a callback with someone knowledgeable about [fill: ALIAS of Sample Adult]'s
health be arranged?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Arrange Proxy Callback
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '1' is entered, display 'Yes'.
Skip Instructions
<1> [goto callbk.ACALLBK1]
<2> store '3' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.025
Variable Name
SADATE
Universe
(SADULT = '1' (available)) or (SADULT = '3' (condition prohibits responding) and
PROX1 = '1' (yes) and PROX2 = response)
Universe-text
Sample Adult section has been started with either the Sample Adult or a proxy.
Question Text
Answer Codes
Question Type
Output Storage Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if SADATE = empty
If SADULT = '1' (available)
set SADATE = CDATE (current date) (now called ComputationDate)
elseif SADULT = '3' (condition prohibits responding) and PROX1 = '1' (yes) and PROX2
= response
set SADATE = CDATE (current date) (now called ComputationDate)
endif
This is an output variable that should be in the format 'MMDDYYYY'.
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.026
Variable Name
SATIME
Universe
(SADULT = '1' (available)) or (SADULT = '3' (condition prohibits responding) and
PROX1 = '1' (yes) and PROX2 = response)
Universe-text
Sample Adult section has been started with either the Sample Adult or a proxy.
Question Text
Answer Codes
Question Type
Output Storage Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if SATIME = empty
If SADULT = '1' (available)
set SATIME = current time
elseif SADULT = '3' (condition prohibits responding) and PROX1 = '1' (yes) and PROX2
= response
set SATIME = current time
endif
This is an output variable that should be in the format 'HH:MM [ fill:a.m./p.m.]'.
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.030
Variable Name
AIDVERF_S
Universe
(RELRESP_A ne Sample Adult and HHRESP ne Sample Adult) or PROX1 = '1'
Universe-text
Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 =
'Yes'.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Verified Adult's Sex
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the most recently updated sex to the right of the answer box
in the field pane, e.g., if '1' is the current answer, display 'Male'.
Skip Instructions
<1> [goto AIDVERF_A]
<2> [goto AIDSEX]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.040
Variable Name
AIDSEX
Universe
AIDVERF_S = '2' (No)
Universe-text
Respondent said his/her sex is not correct.
Question Text
Are you Male or Female?
*If don't know or refused enter your best guess.
Answer Codes
1. Male
2. Female
Question Type
Pick One - answer list pane
Field Pane Description
Adult's Revised Sex
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the sex for the answer entered in this question to the right of
the answer box in the field pane, e.g., if '2' is entered, display 'Female'.
Skip Instructions
<1,2> store AIDSEX in SEX
[goto ERR_AIDSEX]
reset AIDVERF_S
[goto AIDVERF_S]
Hard Edits
ERR_AIDSEX
*The gender will now be changed to [fill: AIDSEX].
goto AIDVERF_S (as the default goto)
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.045
Variable Name
AIDVERF_A
Universe
AIDVERF_S = '1'
Universe-text
Sample Adult said his/her sex is correct.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Fill Instructions
Verified Adult's Age
If Sample Adult's age in AGE is > "0"
[fill: years]
else
[fill: less than a year]
endif
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the most recently updated age in years to the right of the answer box in the field
pane, e.g., if the age is '32' display '32 years old'. For the case where the age is '0'
years, display 'less than a year old'. This last situation should rarely, if ever, occur, but
it is here just in case.
Skip Instructions
<1> [goto AIDVERF_D]
<2> [goto AIDAGE]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.050
Variable Name
AIDAGE
Universe
AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her age is not correct
Question Text
How old are you?
Answer Codes
Question Type
Integer
Field Pane Description
Adult's Revised Age
Fill Instructions
Special Instructions Hard code the phrase 'year(s) old' to the right of the answer box in the field pane.
Skip Instructions
<0-120, Refused, Don't know>
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
[goto ERR_AIDAGE]
else
store AIDAGE in AGE
[goto AIDDOB_M]
Hard Edits
Soft Edits
ERR_AIDAGE
*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
goto AIDVERF_A (whether suppressed or not)
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.055
Variable Name
AIDVERF_D
Universe
AIDVERF_A = '1'
Universe-text
Sample Adult said his/her age is correct.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Fill Instructions
Verified Adult's Date of Birth
[fill: , ] = date of birth, where should be filled with
the name of the month, not the number. For any part of the birth date that is "refused",
"don't know", or otherwise "blank", put a "?" for that field.
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the Sample Adult's date of birth to the right of the answer box in the field pane.
For any part of the birth date that is "refused", "don't know", or otherwise "blank", put a
"?" for that field.
Skip Instructions
<1> if AGE of Sample Adult le '17'
[goto NO_MORE]
else
[goto beginning of adult.asd]
endif
<2> [goto AIDDOB_M]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_1
Variable Name
AIDDOB_M
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
1 of 3
What is your birthday?
*Enter month of birth.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Adult's Revised Month of Birth
Fill Instructions
Special Instructions Display the name of the month for the answer entered in this question to the right of the
answer box in the field pane, e.g., if '10' is entered, display 'October'. If 'Refused' or
'Don't know' is entered, do not display anything to the right of the answer box.
Skip Instructions
<01-12,R, D> [goto AIDDOB_D]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_2
Variable Name
AIDDOB_D
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
2 of 3
*Enter day of birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Adult's Revised Day of Birth
[fill2: AIDDOB_M] = month of birth, where should be filled with the name
of the month, not the number.
Special Instructions Only allow valid days for month entered.
Skip Instructions
<01-31,R,D> [goto AIDDOB_Y]
If days not valid, [goto ERR_AIDDOB_D]
Hard Edits
ERR_AIDDOB_D
*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M].
*Please correct.
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_3
Variable Name
AIDDOB_Y
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
3 of 3
*Enter year of birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Adult's Revised Year of Birth
[fill1: , ] = date of birth, where
should be filled with the name of the month, not the number. For any part of the birth
date that is "refused", "don't know", or otherwise "blank", put a "?" for that field.
[fill3: , ] = date of birth, where should be filled
with the name of the month, not the number. For any part of the birth date that is
"refused", "don't know", or otherwise "blank", put a "?" for that field.
Special Instructions
Skip Instructions
<1880-2020,R,D> if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
[goto AIDVERF_A]
elseif AIDVERF_D = '2' (No) then reset
AIDVERF_D to empty
[goto AIDVERF_D]
endif
(if year GT current year) or (if year = current year and month GT current month) or (if
year = current year and month = current month and day GT current day)
[goto ERR1_AIDDOB_Y]
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
[goto ERR2_AIDDOB_Y]
endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref'
or 'DK')
goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
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goto AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y
endif
Hard Edits
ERR1_AIDDOB_Y
*Future date invalid: [fill1: , ]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: , ]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: , ]
goto AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.
* If still cannot reconcile, enter 'Don't know' for year of birth.
* Please correct.
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.070
Variable Name
NO_MORE
Universe
[(ASTAT = empty or ASTAT = '2') and HHSTAT4 = 'S' and AGE le '17']
Universe-text
Sample adult whose age is now less than or equal to 17
Question Text
* [fill: ALIAS of Sample Adult] is no longer the sample adult for this family.
* You may need to ask additional questions before continuing with the rest of the
interview.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
This Person No Longer Sample Adult
Fill Instructions
Special Instructions
Skip Instructions
Do not allow "Don't Know" or "Refused" as an answer.
<1> (Search and count the number of persons in the family 18+ years old.)
[if (age is now 14-17 inclusive) and (person is married or living with a partner or
there is no one over 17 years old in the family)]
store 'E' in HHSTAT4
store '0' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
else
store empty in HHSTAT4
store '0' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif
endif
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Monday, August 25, 2014
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.075
Variable Name
AAGECHG
Universe
HHSTAT4 = 'S' and ((AIDAGE ne empty and AIDAGE ne original age) OR (AIDSEX ne
empty and AIDSEX ne original sex))
Universe-text
Person is SA and (there is a sex change or an age change)
Question Text
* Because you changed the Sample Adult's sex and / or sex, you may need to ask
additional questions before continuing with the rest of the interview.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.082
Variable Name
LNKINTRO
Universe
HHSTAT4 = 'S'
Universe-text
Sample Adults 18+
Question Text
?[F1]
We would like the last four digits of your Social Security Number [Fill:]. This information
will help us link your survey data with health-related records of other government
agencies, and allow us to conduct additional research without taking up your time with
more questions. The National Center for Health Statistics uses this information for
research purposes only. Providing this information is voluntary. Federal laws authorize
us to ask for this information and require us to keep it strictly private. There will be no
effect on your benefits if you do not provide this information.
* Read if necessary: The specific federal laws are the Public Health Service Act (Title
42, United States Code, Section 242K) and the Confidential Information Protection and
Statistical Efficiency Act (Title V of Public Law 107-347).
* Enter '1' to continue.
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Linkage intro
Fill: If sample adult has Medicare (HIKIND=2 or HIKIND=3 or MCAREPRB=1), then
fill ", and the last four numbers and any letters of your Medicare number"
else
fill nothing
Special Instructions QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
<1,D> [goto SASSN4]
[goto SARLINK]
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H_LNKINTRO
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.082_H
Variable Name
H_LNKINTRO
Universe
Universe-text
Question Text
NHIS data have been linked with health-related records of government agencies such
as the Centers for Medicare and Medicaid Services and the Social Security
Administration. NHIS data have also been linked with death certificate data stored in
the National Death Index (NDI). The NDI is a database of death certificate information
provided to NCHS by State offices.
All personal identifying information is removed from the linked data files.
These are some examples of possible research studies using NHIS data together with
other health-related records or the NDI:
[blt] Predicting the number of disabled persons in the U.S. based on health conditions
reported in the NHIS.
[blt] Predicting the costs of Medicare based on health conditions reported in the NHIS.
[blt] Studying the risk of certain diseases for persons with and without health insurance.
[blt] Studying the health characteristics of people who retire early.
[blt] Calculating how long a person in the U.S. might live, based on his or her education,
income, or race and ethnicity.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
LNKINTRO
SARLINK
SASSN4
SCSSN4
SCRLINK
Skip Instructions
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Monday, August 25, 2014
Page 19 of 28
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.085
Variable Name
SASSN4
Universe
HHSTAT4 = S and (LNKINTRO= '1' or LNKINTRO = 'don't know')
Universe-text
Sample adults 18+ who answered "Enter 1 to continue" or "don’t know" at LNKINTRO
Question Text
?[F1]
What are the last four digits of your Social Security Number?
* Read if necessary: Providing this information is voluntary. Federal laws authorize us
to ask for this information and require us to keep it strictly private (Public Health Service
Act, which is Title 42, United States Code, Section 242K; and the Confidential
Information Protection and Statistical Efficiency Act, which is Title V of Public Law 107347).
* Enter 'N' if no Social Security Number.
Answer Codes
Question Type
Integer
Field Pane Description
SSN
Fill Instructions
Special Instructions Allow 4 digits. QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE
ADULT CORE AND SUPPLEMENT QUESTIONS.
NOTE: THIS QUESTION ACTUALLY APPEARS AT THE END OF THE SAMPLE
ADULT QUESTIONS INCLUDING ANY SUPPLEMENT QUESTIONS IN THE
INSTRUMENT. THIS IS LOCATED HERE BECAUSE NCHS WANTED THE OUTPUT
DATA TO CONTAIN THIS INFORMATION HERE.---T.M.
Skip Instructions
<0001-9999> if SCSSN4=SASSN4 goto ERR2_SASSN4];
else [goto SASSNRP4]
<0-999> [goto ERR_SASSN4]
<0000> [goto ERR3_SASSN4]
if HIKIND=2 or HIKIND = 3 or MCAREPRB=1
[goto SAMCNO4]
else
[goto SARLINK]
Hard Edits
ERR_SASSN4
* You must enter all four of the last four digits of the Social Security Number.
*Please correct.
ERR3_SASSN4
* The last 4 digits of a SSN may be between 0001-9999.
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* Please correct.
* For a respondent who does not want to provide the SSN, enter 'Ctrl D' or 'Ctrl R' for
'Don't Know' or 'Refused.'
Soft Edits
ERR2_SASSN4
*The last four digits of [fill: ALIAS of Sample Adult]'s Social Security Number are the
same as the last four digits of [SC name]'s Social Security Number. Please verify.
*First goto change Sample Adult's SSN at SASSN4
*Second goto change Sample Child's SSN at SCSSN4
AssocHelp
H_LNKINTRO
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.090
Variable Name
SASSNRP4
Universe
HHSTAT4 = S and ('0000' <= SASSN4 <='9999')
Universe-text
Sample adult reported the last four digits of the SSN at SASSN4
Question Text
* Enter how the last four digits of the Social Security Number were reported.
Answer Codes
1. From memory
2. From records
Question Type
Pick One - answer list pane
Field Pane Description
SSN memory or records
Fill Instructions
Special Instructions Do not allow Refused or Don't know
QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
<1,2> [goto SASSNTL4]
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Monday, August 25, 2014
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.095
Variable Name
SASSNTL4
Universe
HHSTAT4 = S and (SASSNRP4 = 1 or 2)
Universe-text
Recorded how last four digits of the sample adult’s SSN were reported
Question Text
* Select one category below to indicate reporting of the last four digits of the Social
Security Number.
Answer Codes
1. In person
2. Telephone
Question Type
Pick One - answer list pane
Field Pane Description
SSN in person or phone
Fill Instructions
Special Instructions Do not allow Refused or Don't know
QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
NOTE: THIS IS LOCATED HERE BECAUSE NCHS WANTED THE OUTPUT DATA
TO CONTAIN THIS INFORMATION HERE.---T.M.
Skip Instructions
<1,2> if HIKIND= 2 or HIKIND = 3 or MCAREPRB=1
[goto SAMCNO4]
else
[goto AWB.AWEBUSE (AWB.010_00.000)]
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Monday, August 25, 2014
Page 22 of 28
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_1
Variable Name
SAMCNO4
Universe
HHSTAT4 = S and (LNKINTRO = 1 or LNKINTRO = don't kow) and (HIKIND = 2 or
HIKIND = 3 or MCAREPRB = 1)
Universe-text
Sample adult has Medicare
Question Text
? [F1]
1 of 2
May I please see your Medicare card to record the last four numbers and any letters of
the Health Insurance Claim Number?
* Read if necessary: Providing this information is voluntary. Federal laws authorize us
to ask for this information and require us to keep it strictly private (Public Health Service
Act, which is Title 42, United States Code, Section 242K; and the Confidential
Information Protection and Statistical Efficiency Act, which is Title V of Public Law 107347).
* Reports from memory are acceptable if the Medicare card (or some other form of
documentation) is not available.
* Enter the last four numbers.
Answer Codes
Question Type
Integer
Field Pane Description
Medicare number
Fill Instructions
Special Instructions Allow 4 digits. QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE
ADULT CORE AND SUPPLEMENT QUESTIONS.
If SAMCNO4 = 'Refused'
set SAMCNO4_FLG = 'R'
elseif SAMCNO4 = 'Don't know'
set SAMCNO4_FLG = 'D'
else
set SAMCNO4_FLG = empty
endif
Skip Instructions
<0000-9999> [goto SAMCLET]
<0-999> [goto ERR_SAMCNO4]
[goto SARLINK]
Hard Edits
ERR_SAMCNO4
* You must enter all four of the last four numbers of the Medicare number.
* Please correct.
Monday, August 25, 2014
Page 23 of 28
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H_SAMCNO4
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_2
Variable Name
SAMCLET
Universe
HHSTAT4 = S and SAMCNO4 = 0000 - 9999
Universe-text
Sample adult has Medicare and reported the last four numbers of the Medicare number
Question Text
2 of 2
*Enter the letters that appear after the claim number.
Answer Codes
empty, A - Z, AA - ZZ
Question Type
Text
Field Pane Description
Letters
Fill Instructions
Special Instructions Allow up to 2 letters and allow 'empty'. QUESTION SHOULD APPEAR AT THE END
OF THE SAMPLE ADULT CORE AND SUPPLEMENT QUESTIONS.
Skip Instructions
if SASSN4 = 0000-9999
[goto AWB.AWEBUSE (AWB.010_00.000)]
elseif SASSN4 = 'N','Refused','Don't know'
[goto SARLINK]
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Monday, August 25, 2014
Page 24 of 28
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_3
Variable Name
SAMCNO4_FLG
Universe
Universe-text
Question Text
Answer Codes
Question Type
**Instrument variable**
Field Pane Description
Fill Instructions
Special Instructions If SAMCNO4 = 'Refused'
set SAMCNO4_FLG = 'R'
elseif SAMCNO4 = 'Don't know'
set SAMCNO4_FLG = 'D'
else
set SAMCNO4_FLG = empty
endif
Skip Instructions
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Monday, August 25, 2014
Page 25 of 28
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_H
Variable Name
H_SAMCNO4
Universe
Universe-text
Question Text
Medicare refers to the Federal health insurance coverage for persons 65+ years of age
and certain disabled persons under 65.
NHIS data have been linked with health-related records of government agencies such
as the Centers for Medicare and Medicaid Services and the Social Security
Administration. NHIS data have also been linked with death certificate data stored in
the National Death Index (NDI). The NDI is a database of death certificate information
provided to NCHS by State offices.
All personal identifying information is removed from the linked data files.
These are some examples of possible research studies using NHIS data together with
other health-related records or the NDI:
[blt] Predicting the number of disabled persons in the U.S. based on health conditions
reported in the NHIS.
[blt] Predicting the costs of Medicare based on health conditions reported in the NHIS.
[blt] Studying the risk of certain diseases for persons with and without health insurance.
[blt] Studying the health characteristics of people who retire early.
[blt] Calculating how long a person in the U.S. might live, based on his or her education,
income, or race and ethnicity.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: SAMCNO4
Skip Instructions
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Monday, August 25, 2014
Page 26 of 28
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.105
Variable Name
SARLINK
Universe
HHSTAT4 = S and (LNKINTRO=refused or SAMCNO4=refused or SAMCNO4=don't
know or SASSN4=no SSN or SASSN4=refused or SASSN4=don't know)
Universe-text
Version 2 and Sample Adult answered refused at LNKINTRO, or answered refused or
don't know at SAMCNO4 or answered no SSN or refused or don't know at SASSN4
Question Text
?[F1]
May we try to link your survey data without [Fill:]?
* Read if necessary:
Any data obtained will be kept strictly private as required by law (Public Health Service
Act, which is Title 42, United States Code, Section 242K; and the Confidential
Information Protection y Statistical Efficiency Act, which is Title V of Public Law 107347).
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Permission to link
IF LNKINTRO = RF OR ((SASSN4 = 'N' OR SASSN4 = RF OR SASSN4 = DK) AND
(SAMCNO4 = RF OR SAMCNO4 = DK)) THEN
If ((Medicare IN FHI.ITYPE.ITYPE[SASEL].HIKIND) OR (Medigap IN
FHI.ITYPE.ITYPE[SASEL].HIKIND) OR
(FHI.ITYPE.ITYPE[SASEL].MCAREPRB=Yes)) THEN
Fill := 'Medicare and Social Security numbers'
else
Fill := 'a Social Security Number'
Endif
ELSEIF (SAMCNO4 = RF OR SAMCNO4 = DK) THEN
Fill := 'a Medicare number'
ELSEIF (SASSN4 = RF OR SASSN4 = DK or SASSN4 = 'N') THEN
Fill := 'a Social Security Number'
ENDIF
Special Instructions QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
[goto AWB.AWEBUSE (AWB.010_00.000)]
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H_LNKINTRO
Monday, August 25, 2014
Page 28 of 28
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Socio-Demographic Background
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.050
Variable Name
WRKVER
Universe
HHSTAT4 = S and DOINGLW = 1-5
Universe-text
Sample adults 18+ who were working or not working last week
Question Text
Earlier I recorded that in the last week you were
(Fill1: working for pay at a job or business.)
(Fill2: with a job or business but not at work.)
(Fill3: looking for work.)
(Fill4: working, but not for pay, at a family-owned job or business.)
(Fill5: not working at a job or business and not looking for work.)
Is that correct?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Verify last week's work activity
Fill1: If DOINGLW
Fill2: If DOINGLW
Fill3: If DOINGLW
Fill4: If DOINGLW
Fill5: If DOINGLW
=1
=2
=3
=4
=5
Special Instructions Storage instructions: If WRKVER = 1 then
set DOINGLW2 = DOINGLW and WHYNOWK2 = WHYNOWRK
elseif WRKVER = Refused or Don't know then
set DOINGLW2 = WRKVER
endif
Skip Instructions
<1>if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
<2> [go to WRKCOR]
[go to EVERWRK]
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Monday, August 25, 2014
Page 1 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.060
Variable Name
WRKCOR
Universe
HHSTAT4 = S and [(WRKVER = 2) or (SASEL ne FAMRESP and (DOINGLW =
Refused or Don't know))]
Universe-text
Sample adults 18+ whose working status was incorrect or who were not the Family
Respondent and with an answer of D or R to DOINGLW.
Question Text
(book) A1
? [F1]
What is your correct working status?
* Read answer categories.
Answer Codes
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a family-owned job or business
5. Not working at a job or business and not looking for work
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Correct working status
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Storage instructions: set DOINGLW2 = WRKCOR
Skip Instructions
<1,4> [goto to WHOWRK]
<2,5> [goto WHYNOWK2]
<3,R,D> [goto EVERWRK]
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H_WRKCOR
Monday, August 25, 2014
Page 2 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.060_H
Variable Name
H_WRKCOR
Universe
Universe-text
Question Text
A job exists when there is a definite arrangement for regular work on a continuing
basis, and the person holding the job receives pay or other compensation for his/her
work. The schedule of hours or days can be irregular as long as there is a definite
arrangement to work on a continuing basis.
A business exists when machinery or equipment of substantial value is used in
conducting the business; an office, store, or other place of business is maintained; or
the business is advertised to the public.
An individual is working for pay if he or worked for wages, salary, commission, tips,
piece-rates, or pay-in-kind (e.g., room-and-board); worked for profit in his/her own
business, practice or farm; worked as a civilian for the National Guard or Dept. of
Defense; or performed exchange or share work on a farm.
Have a job or business but not at work includes individuals on annual leave or vacation
(paid or unpaid); on maternity or family leave (paid or unpaid); at jury duty; involved in a
labor dispute that is taking place at his/her place of employment; on sick leave (paid or
unpaid); on a temporary lay-off (lasting less than 30 days), and the person expects to
be called back within that time period.
An individual is looking for work if he or she is conducting an active job search, which
includes filling out applications or sending out resumes; placing or answering classified
ads; checking union/professional registers; bidding on a contract or auditioning for a
part in a play; contacting friends or relatives about possible jobs; contacting
school/college university employment offices; contacting prospective employers
directly; contacting public or private employment offices.
Include as working, but not for pay at least 15 hours of work per week without pay or
compensation in a business or farm operated by a related household member.
Volunteer efforts should not be considered as working. Likewise, unpaid internships
are not considered as working.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKCOR
Skip Instructions
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Page 3 of 57
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Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.062
Variable Name
DOINGLW2
Universe
HHSTAT4 = S and Sample Adult (L_NO) = FAMRESP and (DOINGLW = Refused or
Don't know)
Universe-text
Sample Adults 18+ and also the family section respondent and said Refused or Don't
know to the working last week status question in the family section
Question Text
Corrected Employment Status Last Week: (not displayed)
Answer Codes
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a family-owned job or business
5. Not working at a job or business and not looking for work
Refused
Don't know
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions Storage Instructions:
If (DOINGLW = Refused or Don't know) and Sample Adult (L_NO) = FAMRESP then
set DOINGLW2 = DOINGLW
endif
Skip Instructions
if DOINGLW2 = Refused or Don't know then
[goto EVERWRK]
endif
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Monday, August 25, 2014
Page 4 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.065
Variable Name
WHYNOWK2
Universe
HHSTAT4 = S and WRKCOR = 2,5
Universe-text
Sample Adults 18+ whose corrected working status last week was not working at a job
or business and not looking for work or with a job or business but not at work
Question Text
? [F1]
(Fill1: What is the main reason you did not work last week?)
(Fill2: What is the main reason you did not have a job or business last week?)
Answer Codes
1. Taking care of house or family
2. Going to school
3. Retired
4. On a planned vacation from work
5. On family or maternity leave
6. Temporarily unable to work for health reasons
7. Have job/contract and off-season
8. On layoff
9. Disabled
10. Other
Refused
Don't know
Question Type
Other
Field Pane Description
Fill Instructions
Reason not working last week
Fill1: if WRKCOR = 2
Fill2: if WRKCOR = 5
Special Instructions
Skip Instructions
<1-10,D,R> if WRKCOR = 2 then
[goto WHOWRK]
else [goto EVERWRK]
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H_WHYNOWK2
Monday, August 25, 2014
Page 5 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.065_H
Variable Name
H_WHYNOWK2
Universe
Universe-text
Question Text
Taking care of house or family is any type of work around the house such as cleaning,
cooking, maintaining the yard, caring for children or family, etc.
Going to school means attending any type of public or private educational
establishment both in and out of the regular school system.
Retired, Temporarily unable to work for health reasons, and Disabled are respondent
defined.
On Layoff means that the person is waiting to be called back to a job from which they
have been temporarily laid-off or furloughed. Layoffs can be due to slack work, plant
retooling or remodeling, inventory taking, and the like. Do not consider a person who
was not working because of a labor dispute at his/her own place of employment as
being on layoff.
Have job/contract and off-season includes school personnel (teachers, administrators,
custodians, etc.) on summer vacation who have a definite arrangement, either written
or oral, to return to work in the fall, are not considered to be on layoff during the
summer. They may, however, be laid off from a summer job or looking for work for the
summer months (but this would NOT be considered their main job or employment
activity).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:WRKCOR
Skip Instructions
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Monday, August 25, 2014
Page 6 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.066
Variable Name
EVERWRK
Universe
HHSTAT4 = S and DOINGLW2 = 3,5,Refused,or Don't know
Universe-text
Sample adults 18+ who were NOT working at a job or business and not looking for
work or looking for work last week or didn't know or refused to provide their
employment status last week
Question Text
Have you ever held a job or worked at a business?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever worked
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto WHOWRK]
<2,D,R> [goto SCHOOLYR]
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Monday, August 25, 2014
Page 7 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.070
Variable Name
WHOWRK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
(Fill1:For whom did you work at your MAIN job or business? (Name of company,
business, organization or employer))
(Fill2: Thinking about the job you held the longest, for whom did you work? (Name of
company, business, organization or employer))
(Fill3: Thinking about the job you held most recently, for whom did you work? (Name of
company, business, organization or employer))
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
Whom did you work for
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<90 char long,D,R> [goto KINDIND]
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H_WHOWRK
Monday, August 25, 2014
Page 8 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.070_H
Variable Name
H_WHOWRK
Universe
Universe-text
Question Text
Enter the sample adult's verbatim response for the name of his/her employer, business,
company, or organization.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WHOWRK, WHOWRKPY, WHOWRKLH
Skip Instructions
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Monday, August 25, 2014
Page 9 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.080
Variable Name
KINDIND
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail
shoe store, State Department of Labor)
Answer Codes
Question Type
Text
Field Pane Description
What kind of business/industry
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto KINDWRK]
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H_KINDIND
Monday, August 25, 2014
Page 10 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.080_H
Variable Name
H_KINDIND
Universe
Universe-text
Question Text
Indicate both a general and specific function for employers and businesses. For
example, in "copper mine" the word "mine" is general and the word "copper" is specific.
For Government Agencies: If the title clearly designates the main function of the
agency, enter the name of the agency (e.g., the U.S. Census Bureau.) If the main
function is not clear from the title, ask for and report the division or branch for which the
person works.
For Firms with more than one business: If activities are carried on in separate places,
describe the business in which the person actually worked. If activities are carried on in
the same place, describe the main activity.
For household or domestic workers: Determine if the person works for a business or
private home. If it is a business, enter the name of the business. If it is a private home,
enter "private home".
Manufacturing: Makes and sells its products in large lots to other manufacturers,
wholesalers, or retailers.
Wholesale trade: Buys products in large quantities for resale to retailers, industrial
users, or to other wholesalers.
Retail trade: Sells primarily to individual consumers and seldom makes products.
Some other kinds of business: Any other type of establishment that renders a service to
individuals and/or organizations. Examples are hotels, dry cleaners, advertising
agencies, restaurants, and automobile repair shops.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: KINDIND, KINDINPY, KINDINLH
Skip Instructions
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Monday, August 25, 2014
Page 11 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.090
Variable Name
KINDWRK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer
specialist.)
Answer Codes
Question Type
Text
Field Pane Description
What kind of work
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto IMPACT]
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H_KINDWRK
Monday, August 25, 2014
Page 12 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.090_H
Variable Name
H_KINDWRK
Universe
Universe-text
Question Text
The entry should clearly state the kind of work or nature of duties performed by the
person. The occupation entry should describe what the person does (e.g., shipping
department supervisor, inventory clerk).
One word occupational descriptions are usually not adequate. For example, we need
to know what type of nurse, engineer, clerk, or teacher a person is.
For Example:
Inadequate
Adjuster
adjuster,
Adequate
Claims adjuster, brake adjuster, machine adjuster, merchandise
complaint adjuster, insurance adjuster
Engineer
Civil engineer, locomotive engineer, mechanical engineer,
aerospace engineer
Scientist
economist
Political scientist, physicist, sociologist, oceanographer, home
Teacher
Kindergarten teacher, High school teacher, Special education
teacher, College professor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: KINDIND, KINDWKPY, KINDWKLH
Skip Instructions
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Monday, August 25, 2014
Page 13 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.100
Variable Name
IMPACT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What were your most important activities on this job or business? (For example: sells
cars, keeps account books, operates printing press.)
Answer Codes
Question Type
Text
Field Pane Description
Important activities
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto SUPERVIS]
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H_IMPACT
Monday, August 25, 2014
Page 14 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.100_H
Variable Name
H_IMPACT
Universe
Universe-text
Question Text
Detail the kind of work or duties the person performs.
The entry to this item must include enough additional information for a precise
occupational classification. Usually a few words telling what the person actually does
or the tools he/she uses will suffice.
For example, two people with the same job title, “Telephone Co. serviceman”, may
have different activities such as installing phones in homes or repairing telephone
transmission lines.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: IMPACT, IMPACTPY, IMPACTLH
Skip Instructions
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Monday, August 25, 2014
Page 15 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.105_00.010
Variable Name
SUPERVIS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2 IN
('1','2','4') or EVERWRK='1')
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
* Ask if necessary.
Did you supervise other employees as part of your job?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Supervise
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WRKCAT]
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Monday, August 25, 2014
Page 16 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.110
Variable Name
WRKCAT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(book) A2 ? [F1]
(Fill1: Looking at the card, which of these best describes your current job or work
situation?)
(Fill2: Looking at the card, which of these best describes the job you held for the
longest time?)
(Fill3: Looking at the card, which of these best describes the job you held most
recently?)
* Read answer choices if necessary.
Answer Codes
1. An employee of a PRIVATE company, business, or individual for wages, salary, or
commission
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed in OWN business, professional practice or farm
6. Working WITHOUT PAY in family-owned business or farm
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Class of worker
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1-4,6,D,R>[goto LOCALLNO]
<5> [goto BUSINC]
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H_WRKCAT
Monday, August 25, 2014
Page 17 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.110_H
Variable Name
H_WRKCAT
Universe
Universe-text
Question Text
Private company or business: This employer may be a large corporation or a single
individual, but must not be part of any government organization. This category also
includes work for private organizations doing contract work for government agencies.
Federal government: Include persons working for any branch of the federal government
including persons who were elected to paid federal offices and civilian employees of the
Armed Forces and some members of the National Guard. Include employees of
international organizations like the United Nations and employees of foreign
governments such as a person employed by the French embassy.
State government: Report this category for employees of State governments, which
include paid state officials, state police, employees of state universities and colleges,
and statewide JTPP administrators.
Local government: Report for employees of counties, cities, towns, and other local
areas. Included here would be city-owned bus lines, electrical power companies, water
and sewage services, etc. Employees of public elementary and secondary schools
who worked for local governments should also be here.
Self employed: Person working for profit or fees in their own business, shop, office,
farm, etc. Include persons who have their own tools or equipment and provide services
on a contract, subcontract, or job basis, such as carpenters, plumbers, independent
taxicab operators, or independent truckers.
Working without pay: Working on a farm on in a business operated by a related
member of the household, without receiving wages or salary for work performed.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKCAT, WRKCATPY, WRKCATLH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.112
Variable Name
BUSINC
Universe
HHSTAT4 = S and WRKCAT = 5
Universe-text
Sample adults 18+ who are self-employed
Question Text
Is this business incorporated?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Incorporated business
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto LOCALLNO]
Hard Edits
Soft Edits
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Monday, August 25, 2014
Page 19 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.120
Variable Name
LOCALLNO
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(book) A3
Thinking about
(Fill1: this MAIN job or business)
(Fill2: your last week at the job you held the longest)
(Fill3: your last week at the job you held most recently)
how many people (Fill4:work/Fill5: worked) at this location? Please include yourself
* "People" includes both FULL- and PART-time employees; "location" refers to the
street address of the workplace.
Answer Codes
1. 1 employee
2. 2-9 employees
3. 10-24 employees
4. 25-49 employees
5. 50-99 employees
6. 100-249 employees
7. 250-499 employees
8. 500-999 employees
9. 1000 employees or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Number of employees
Fill1: If [DOINGLW2 eq <1,2,4>]
Fill2: if [EVERWRK eq <1> and (WHYNOWK2 eq 03 or AGE ge 65)]
Fill3: if [EVERWRK eq <1> and WHYNOWK2 ne 03 and AGE lt 65]
Fill4: if [DOINGLW2 eq <1,2,4>
Fill5: if [EVERWRK eq 1]
Special Instructions
Skip Instructions
<1-8, R,D> [goto WRKLONGN]
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Monday, August 25, 2014
Page 20 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_01
Variable Name
WRKLONGN
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
1 of 2
About how long
(Fill1: have you worked at this MAIN job or business?)
(Fill2: did you work at the job you held the longest?)
(Fill3: did you work at the job you held most recently?)
* Enter number.
Answer Codes
1-365
Refused
Don't know
Question Type
Integer
Field Pane Description
Fill Instructions
Duration at this job: Number of units
Fill1: If DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = <1> and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = <1> and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions Store D,R in WRKLONGT
Skip Instructions
<1-365> [goto WRKLONGT]
if EVERWRK eq 1 and (WHYNOWK2 eq 03 or AGE GE 65)
[goto HOURPD] ;
Else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or
(DOINGLW2 = 1,2,4)
[goto WRKLONGH]
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H_WRKLONGN
Monday, August 25, 2014
Page 21 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_01_H
Variable Name
H_WRKLONGN
Universe
Universe-text
Question Text
Main job or business refers to the job or business which is the primary source of a
person's income.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKLONGN
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 22 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_02
Variable Name
WRKLONGT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1) and WRKLONGN ne
Refused or Don't know
Universe-text
Sample adults 18+ (who were working last week, or who were with a job or business
but not at work, or who were working but not for pay at a family-owned job or business,
or who have ever worked) and who gave a number entry in WRKLONGN
Question Text
2 of 2
* Enter time period.
Answer Codes
1. Days(s)
2. Week(s)
3. Month(s)
4. Year(s)
Question Type
Pick One - answer list pane
Field Pane Description
Duration at this job: Time units
Fill Instructions
Special Instructions
Skip Instructions
<4> if WRKLONGN gt AGE then [goto ERR_WRKLONGT]
<1-4> if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]
else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or
(DOINGLW2 = 1,2,4) [goto WRKLONGH]
Hard Edits
ERR_WRKLONGT
* Number of years is greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.146
Variable Name
WRKLONGH
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or (EVERWRK = 1 and WHYNOWK2 ne 3
and AGE lt 65))
Universe-text
Sample adults 18+ (who were working last week, or who were with a job or business
but not at work, or who were working but not for pay at a family-owned job or business,)
or (who have ever worked and are not retired and are less than 65 years of age.)
Question Text
? [F1]
(Fill1: Is this MAIN job or business the job you have held for the longest?)
(Fill2: Was your most recently held job also the job you held the longest?)
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Longest job
[Fill1: If DOINGLW2 eq 1,2,4, ]
[Fill2: if EVERWRK eq 1 and WHYNOWK2 ne 03 and AGE lt 65 ]
Special Instructions
Skip Instructions
<1,2,R,D> [goto HOURPD]
Hard Edits
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H_WRKLONG
Monday, August 25, 2014
Page 24 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.150
Variable Name
HOURPD
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(Fill1: Are you paid by the hour at this MAIN job or business?)
(Fill2: Were you paid by the hour on the job you held the longest?)
(Fill3: Were you paid by the hour on the job you held most recently?)
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Paid by the hour
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1,2,D,R> [goto PDSICK]
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Monday, August 25, 2014
Page 25 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.160
Variable Name
PDSICK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(Fill1: Do you have paid sick leave on this MAIN job or business?
(Fill2: Did you ever have paid sick leave on the job you held the longest?
(Fill3: Did you ever have paid sick leave on the job you held most recently?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Paid sick leave
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1,2,D,R>
if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else if DOINGLW2=3,5 then [goto WRKLYR2];
else if DOINGLW2=D, R then [goto next section]
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Monday, August 25, 2014
Page 26 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.170
Variable Name
ONEJOB
Universe
HHSTAT4 = S and DOINGLW2 = 1,2,4
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business
Question Text
Do you have more than one job or business?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
More than one job
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if WRKLONGH=2, then [goto WHOWRKLH];
else [goto WRKARRNG]
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Monday, August 25, 2014
Page 27 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.210_00.000
Variable Name
WRKLYR2
Universe
HHSTAT4 =’S’ and AGE ge ‘18’ and (DOINGLW2 IN (’3’, ‘5’))
Universe-text
Sample adults 18+ who were looking for work or who were not working at a job or
business AND who were not looking for work in the last week
Question Text
? [F1]
Although you did not work last week, did you have a job or business at any time in the
PAST 12 MONTHS?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Worked past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto next section]
Hard Edits
Soft Edits
AssocHelp
H_WRKLYR2
Monday, August 25, 2014
Page 28 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.210_00.000_H
Variable Name
H_WRKLYR2
Universe
Universe-text
Question Text
A job exists when there is a definite arrangement for regular work on a continuing
basis, and the person holding the job receives pay or other compensation for his/her
work. The schedule of hours or days can be irregular as long as there is a definite
arrangement to work on a continuing basis.
Include:
Persons who worked for wages, salary, commission, tips, piece-rates, or pay-in-kind.
Unpaid workers in a family business or farm, persons who worked without pay on a
farm or unincorporated business operated by a
related member of the household
A business exists when machinery or equipment of substantial value is used in
conducting the business; an office, store, or other place of business is maintained; or
the business is advertised to the public.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKLYR2
Skip Instructions
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Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.010
Variable Name
WHOWRKLH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
? [F1]
Thinking of ALL the jobs or businesses you have ever had, including work done in the
Armed Forces, for whom did you work the longest? (Name of company, business,
organization or employer)
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
Whom did you work for
Fill Instructions
Special Instructions Use Help Screen H_WHOWRK
Skip Instructions
[goto KINDINLH]
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Monday, August 25, 2014
Page 30 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.020
Variable Name
KINDINLH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail
shoe store, State Department of Labor)
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
What kind of business/industry
Fill Instructions
Special Instructions Use Help Screen H_KINDIND
Skip Instructions
[goto KINDWKLH]
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Monday, August 25, 2014
Page 31 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.030
Variable Name
KINDWKLH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer
specialist
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
What kind of work
Fill Instructions
Special Instructions Use Help Screen H_KINDWRK
Skip Instructions
[goto IMPACTLH]
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Monday, August 25, 2014
Page 32 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.040
Variable Name
IMPACTLH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
? [F1]
What were your most important activities on this job or business? (For example: sell
cars, keeps account books, operates printing press)
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
Important activities
Fill Instructions
Special Instructions Use Help Screen H_IMPACT
Skip Instructions
[goto WRKCATLH]
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Monday, August 25, 2014
Page 33 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.050
Variable Name
WRKCATLH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
(book) A2 ? [F1]
Looking at the card, which of these best describes the job or business you held for the
longest time?
Answer Codes
1. An employee of a PRIVATE company, business, or individual for wages, salary, or
commission
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed in OWN business, professional practice or farm
6. Working WITHOUT PAY in family-owned business or farm
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Class of worker
Fill Instructions
Special Instructions Use Help Screen H_WRKCAT
Skip Instructions
<1-6,R,D> [goto WRKLGLHN]
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Monday, August 25, 2014
Page 34 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.060
Variable Name
WRKLGLHN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2'
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Question Text
1 of 2
About how long did you work at the job or business you held the longest?
* Enter number.
Answer Codes
1-365
Refused
Don't know
Question Type
Integer
Field Pane Description
Duration at this job: Number of units
Fill Instructions
Special Instructions Store R,D in WRKLGLHT
Skip Instructions
<1-365> [goto WRKLGLHT]
[if DOINGLW2 IN (1,2,4), goto WRKARRNG; else goto ACN.HYPEV]
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Monday, August 25, 2014
Page 35 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.070
Variable Name
WRKLGLHT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKLONGH='2' and WRKLONGN not IN ('R','D')
Universe-text
Sample adults 18+ whose current, MAIN job is NOT the job they held the longest and
who gave a number at WRKLGLHN
Question Text
2 of 2
* Enter time period.
Answer Codes
1. Days(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Duration at this job: Time units
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [if DOINGLW2 IN(1,2,4) then goto WRKARRNG; else goto ACN.HYPEV]
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Monday, August 25, 2014
Page 36 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.080
Variable Name
WRKARRNG
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
The next set of questions refers to your [fill: job as a (KINDWRK) with
(WHOWRK)/current, MAIN job]. Which of the following best describes your work
arrangement?
* Read categories below.
Answer Codes
1. You work as an independent contractor, independent consultant, or freelance worker
2. You are paid by a temporary agency
3. You work for a contractor who provides workers and services to others under contract
4. You are a regular, permanent employee (standard work arrangement)
5. Some other work arrangement
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Work arrangement
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions
Skip Instructions
<1-5,R,D> [goto WRKSCHED]
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Monday, August 25, 2014
Page 37 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.080_H
Variable Name
H_WRKARRNG
Universe
Universe-text
Question Text
If the phrase “your current, MAIN job” is included in the question text, we are referring
to the MAIN job the respondent held last week (and reported on earlier).
If the respondent started a new job the week of the interview, we still want him/her to
answer about the MAIN job or business he/she held last week (and reported on earlier).
Also, if the respondent is no longer working the MAIN job or business he/she held last
week (and reported on earlier), we still want him/her to answer about that job.
Answer Codes
Question Type
Help screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WORUNEMP, HARASSED, SAFETY, WORKWFAM, EXERTION
Skip Instructions
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Soft Edits
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Monday, August 25, 2014
Page 38 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.090
Variable Name
WRKSCHED
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
Which of the following best describes the hours you usually work?
* Read categories below.
Answer Codes
1. A regular daytime schedule
2. A regular evening shift
3. A regular night shift
4. An irregular schedule such as rotating shifts, split shifts, or some other schedule
where the hours change from day to day or week to week
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Work schedule
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto NIGHTWK]
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Monday, August 25, 2014
Page 39 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.090_H
Variable Name
H_WRKSCHED
Universe
Universe-text
Question Text
A regular daytime schedule: this is when most of your shift is between the hours of 6
AM and 6 PM.
A regular evening shift: this is when most of your shift is between the hours of 2 PM
and midnight.
A regular night shift: this is when most of your shift is between the hours of 9 PM and 8
AM.
Irregular schedules include:
A rotating shift: a work shift that changes periodically from days to evenings or nights.
A split shift: consisting of two distinct work periods each day.
Any other schedule.
If the respondent started a new job the week of the interview, we still want him/her to
answer about the MAIN job or business he/she held last week (and reported on earlier).
Also, if the respondent is no longer working the MAIN job or business he/she held last
week (and reported on earlier), we still want him/her to answer about that job.
Answer Codes
Question Type
Help screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.100
Variable Name
NIGHTWK
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
DURING THE PAST 30 DAYS, did you work ANY amount of time between 1:00 AM
and 5:00 AM?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Night work
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto NIGHTFRQ]
<2,R,D> [goto WORKWFAM]
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Monday, August 25, 2014
Page 41 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.100_H
Variable Name
H_NIGHTWK
Universe
Universe-text
Question Text
If the respondent started a new job the week of the interview, we still want him/her to
answer about the MAIN job or business he/she held last week (and reported on earlier).
Also, if the respondent is no longer working the MAIN job or business he/she held last
week (and reported on earlier), we still want him/her to answer about that job.
Answer Codes
Question Type
Help screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: NIGHTFRQ, HARASFRQ, SAFCLIMT, JOBDMAND, JOBCNTRL,
JOBSPPRT, STAND, SMOKEXP, HLTHPROM, HPROMPAR
Skip Instructions
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Monday, August 25, 2014
Page 42 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.105
Variable Name
NIGHTFRQ
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and NIGHTWK='1'
Universe-text
Sample adults 18+ who are currently employed and worked between the hours of 1:00
AM and 5:00 AM during the past 30 days
Question Text
? [F1]
DURING THE PAST 30 DAYS, on how many days did you work ANY amount of time
between 1:00 AM and 5:00 AM?
Answer Codes
1-30
Refused
Don't know
Question Type
Integer
Field Pane Description
Night work - days
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-30,R,D> [goto WORKWFAM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.110
Variable Name
WORKWFAM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
These next four questions ask about your [fill: job as a (KINDWRK) with
(WHOWRK)/current, MAIN job]. Please tell me whether you strongly agree, agree,
disagree, or strongly disagree with each of these statements.
"The demands of my job interfere with my personal or family life."
Answer Codes
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Work-family balance
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions Use Help Screen H_WRKARRNG
Skip Instructions
<1-4,R,D> [goto JOBDMAND]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.120
Variable Name
JOBDMAND
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or
strongly disagree with this statement.
"I have enough time to get the job done."
Answer Codes
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Job demands
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-4,R,D> [goto JOBCNTRL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 45 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.130
Variable Name
JOBCNTRL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or
strongly disagree with this statement.
"My job allows me to make a lot of decisions on my own."
Answer Codes
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Job control
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-4,R,D> [if WRKCAT=5, then goto WORUNEMP; else goto JOBSPPRT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 46 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.140
Variable Name
JOBSPPRT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKCAT ne '5'
Universe-text
Sample adults 18+ who are currently employed but not self-employed
Question Text
? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or
strongly disagree with this statement.
"I can count on my supervisor or manager for support when I need it."
Answer Codes
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Job support
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-4,R,D> [goto WORUNEMP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 47 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.150
Variable Name
WORUNEMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
Are you worried about losing your [fill: job as a (KINDWRK) with (WHOWRK)/current,
MAIN job]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Worries over losing job
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions Use Help Screen H_WRKARRNG
Skip Instructions
<1,2,R,D> [goto SAFETY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 48 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.160
Variable Name
SAFETY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
The next two questions are about workplace safety and health. Please answer for your
[fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job].
Overall, how safe do you think your workplace is? Would you say…
* Read categories below.
Answer Codes
1. Very safe
2. Safe
3. Unsafe
4. Very unsafe
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Is workplace safe
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions Use Help Screen H_WRKARRNG
Skip Instructions
<1-4,R,D> [if WRKCAT=5 goto HARASSED; else goto SAFCLIMT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 49 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.170
Variable Name
SAFCLIMT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKCAT ne '5'
Universe-text
Sample adults 18+ who are currently employed but not self-employed
Question Text
? [F1]
Please tell me whether you strongly agree, agree, disagree, or strongly disagree with
this statement. "The health and safety of workers is a high priority with management
where I work."
Answer Codes
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Safety climate
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-4,R,D> [goto HARASSED]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.180
Variable Name
HARASSED
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
Again, think about your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job].
DURING THE PAST 12 MONTHS, were you threatened, bullied, or harassed by
anyone while you were on the job?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Harassment
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions Use Help Screen H_WRKARRNG
Skip Instructions
<1> [goto HARASFRQ]
<2,R,D> [goto EXERTION]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.185
Variable Name
HARASFRQ
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and HARASSED='1'
Universe-text
Sample adults 18+ who are currently employed and were threatened, bullied, or
harassed while on the job in the past 12 months
Question Text
? [F1]
DURING THE PAST 12 MONTHS, how often were you threatened, bullied, or harassed
by anyone while you were on the job? Would you say...
* Read categories below.
Answer Codes
1. Once
2. A few times
3. Monthly
4. Weekly
5. Daily
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Harassment - frequency
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1-4,R,D> [goto EXERTION]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.190
Variable Name
EXERTION
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
Again, continue thinking about your [fill: job as a (KINDWRK) with (WHOWRK)/current,
MAIN job]. How often does your job involve repeated lifting, pushing, pulling, or
bending? Would you say...
* Read categories below.
Answer Codes
0. Never
1. Seldom
2. Sometimes
3. Often
4. Always
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Repeated activities
if KINDWRK not IN (R,D) and WHOWRK not IN (R,D) then fill: "job as a (KINDWRK)
with (WHOWRK)"; else fill "current, MAIN job"
Special Instructions Use Help Screen H_WRKARRNG
Skip Instructions
<0-4,R,D> [goto STAND]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 53 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.200
Variable Name
STAND
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
How often does your job involve standing or walking around? Would you say...
* Read categories below.
Answer Codes
0. Never
1. Seldom
2. Sometimes
3. Often
4. Always
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Standing or walking
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<0-4,R,D> [goto SMOKEXP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.210
Variable Name
SMOKEXP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4')
Universe-text
Sample adults 18+ who are currently employed
Question Text
? [F1]
DURING THE PAST 12 MONTHS, while at work, how often were you exposed to
tobacco smoke from other people? Would you say...
* Read categories below.
Answer Codes
0. Never
1. Less than twice a week
2. Twice a week or more, but not every day
3. Every day
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Smoke exposure
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<0-3,R,D> [if WRKCAT=5, then goto ACN.HYPEV; else goto HLTHPROM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 55 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.230
Variable Name
HLTHPROM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKCAT ne '5'
Universe-text
Sample adults 18+ who are currently employed but not self-employed
Question Text
? [F1]
In the past year, were health promotion programs made available to you by your
employer? Examples of health promotion programs include education about weight
management, smoking cessation, screening for high blood pressure, high cholesterol,
or other health risks, and onsite fitness facilities or discounted gym memberships.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Health promotion
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<1> [goto HPROMPAR]
<2,R,D> [goto ACN.HYPEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 57
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.220_00.240
Variable Name
HPROMPAR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2 IN
('1','2','4') and WRKCAT ne '5' and HLTHPROM='1'
Universe-text
Sample adults 18+ who are currently employed but not self-employed and their
employers offer health promotion programs
Question Text
? [F1]
How often did you participate in any of these activities in the past year? Would you say...
* Read categories below.
Answer Codes
0. Never
1. Once
2. A few times
3. Monthly
4. Weekly
5. Daily
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Participation
Fill Instructions
Special Instructions Use Help Screen H_NIGHTWK
Skip Instructions
<0-5,R,D> [goto ACN.HYPEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 57
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Conditions
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.010_00.000
Variable Name
HYPEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now I am going to ask you about certain medical conditions.
Have you EVER been told by a doctor or other health professional that you had
... Hypertension, also called high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hypertension - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HYPDIFV]
<2,R,D> [goto HYBPCKNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.010_H
Variable Name
H_HYPEV
Universe
Universe-text
Question Text
Include only reports of hypertension/high blood pressure by a doctor or other health
care professional. Do not include home blood pressure testing and testing by a
machine in a mall, store or other commercial area. Do not include reports of potential
hypertension or borderline hypertension.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens
HYPEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.020_00.000
Variable Name
HYPDIFV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HYPEV(e)='1'
Universe-text
Sample adults 18+ who were told they had hypertension
Question Text
Were you told on two or more DIFFERENT visits that you had hypertension, also called
high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hypertension - 2+ visits
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1> [goto HYPYR]
<2,R,D> [goto HYPMDEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.020_00.010
Variable Name
HYPYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HYPEV(e) = '1' and
HYPDIFV='1'
Universe-text
Sample adults 18+ who were ever told they had hypertention (2+ visits)
Question Text
DURING THE PAST 12 MONTHS, have you had hypertension, also called high blood
pressure?
*Enter '1' if respondent is taking medication to control his/her high blood pressure.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Past 12 months hypertension
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HYPMDEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.022_02.020
Variable Name
HYPMDEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and HYPEV(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had high blood pressure
Question Text
Was any medicine EVER prescribed by a doctor for your high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HYPMED2]
<2,R,D> [goto CHLEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.022_03.030
Variable Name
HYPMED2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and HYPMDEV2(e)='1'
Universe-text
Sample adults 18+ who were ever prescribed medicine for high blood pressure
Question Text
Are you NOW taking any medicine prescribed by a doctor for your high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHLEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_00.010
Variable Name
CHLEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had high
cholesterol?
*Enter '1' if respondent is taking medication to control his/her high cholesterol.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
High cholesterol-ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHLYR]
<2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_00.020
Variable Name
CHLYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CHLEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had high cholesterol
Question Text
DURING THE PAST 12 MONTHS, have you had high cholesterol?
*Enter '1' if respondent is taking medication to control his/her high cholesterol.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
High cholesterol
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHLMDEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_03.030
Variable Name
CHLMDEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and CHLEV(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had high cholesterol
Question Text
Was any medication EVER prescribed by a doctor to help lower your cholesterol?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHLMDNW2]
<2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_04.040
Variable Name
CHLMDNW2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and CHLMDEV2(e)='1'
Universe-text
Sample adults 18+ who were ever prescribed medicine for high cholestrol
Question Text
Are you NOW taking any medicine prescribed by a doctor to help lower your
cholesterol?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_01.000
Variable Name
CHDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
... Coronary heart disease?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Coronary heart disease -ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ANGEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_02.000
Variable Name
ANGEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
... Angina, also called angina pectoris?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Angina -ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MIEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_03.000
Variable Name
MIEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A heart attack (also called myocardial infarction)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Heart attack - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HRTEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04.000
Variable Name
HRTEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Any kind of heart condition or heart disease (other than the ones I just asked about)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Heart condition/disease - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto STREV]
Hard Edits
Soft Edits
AssocHelp
H_HRTEV
Monday, August 25, 2014
Page 14 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04_H
Variable Name
H_HRTEV
Universe
Universe-text
Question Text
Include as heart disease or heart condition any of the following: heart failure, chronic
heart condition, rheumatic heart disease, atrial or mitral valve disease/damage, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens
HRTEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_05.000
Variable Name
STREV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A stroke?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stroke - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPHEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_06.000
Variable Name
EPHEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Emphysema?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Emphysema - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COPDEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.035_00.000
Variable Name
COPDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had chronic
obstructive pulmonary disease, also called COPD?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
COPD - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [if AGE GE 40, goto ASPMDMED;
else goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.010
Variable Name
ASPMEDEV
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999'))
Universe-text
Sample adults 40+
Question Text
Has a doctor or other health professional EVER told you to take a low-dose aspirin
each day to prevent or control heart disease?
* If the respondent volunteers they have been told to take an aspirin every other day or
“regularly” for these reasons, enter 1 for “yes.”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ASPMEDAD]
<2,R,D> [goto ASPONOWN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.020
Variable Name
ASPMEDAD
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999')) and ASPMEDEV(e)='1'
Universe-text
Sample adults 40+ who have ever been advised to take a low-dose aspirin every day to
prevent or control heart disease
Question Text
Are you NOW following this advice?
* If the respondent provides an answer such as “sometimes,” “occasionally,” or “from
time to time,” enter 1 for “yes."
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Following advice
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto AASMEV]
<2> [goto ASPMDMED]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.030
Variable Name
ASPMDMED
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999')) and ASPMEDEV(e)='1'
and ASPMEDAD='2'
Universe-text
Sample adults 40+ who have ever been advised to take aspirin every day, but are not
currently following that advice
Question Text
Did a doctor or other health professional advise you to stop taking a low-dose aspirin
every day?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stop taking low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.040
Variable Name
ASPONOWN
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999') and ASPMEDEV(e)
IN('2','7','9')
Universe-text
Sample adults 40+ who have not been advised to take aspirin every day or Ref/DK if
they have been advised to take aspirin every day
Question Text
On your own, are you now taking a low-dose aspirin each day to prevent or control
heart disease?
* If the respondent volunteers they are taking an aspirin every other day or “regularly”
for these reasons, enter 1 for “yes.”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Taking low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 22 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.080_00.000
Variable Name
AASMEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Have you EVER been told by a doctor or other health professional that you had asthma?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Asthma - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AASSTILL]
<2,R,D> [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Monday, August 25, 2014
Page 23 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.080_H
Variable Name
H_AASMEV
Universe
Universe-text
Question Text
Accept asthma of any kind such as smoker's asthma, bronchial asthma, allergic
asthma, and the like. Do not accept self-diagnosed lung problems or conditions
reported by a person who is not a doctor
and not working with or for a doctor.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
AASMEV, AASMYR, AASMERYR, AASSTILL
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 24 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.000
Variable Name
AASSTILL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they have asthma
Question Text
? [F1]
Do you still have asthma?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Asthma - still
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [go to AASMYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.090_00.000
Variable Name
AASMYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had asthma
Question Text
? [F1]
DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma
attack?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Asthma - past 12 months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to AASMEV.
Skip Instructions
<1,2,R,D> [goto AASMERYR]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Monday, August 25, 2014
Page 26 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.000
Variable Name
AASMERYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had asthma
Question Text
? [F1]
DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent
care center because of asthma?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Asthma - ER past 12 months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [go to ULCEV]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Monday, August 25, 2014
Page 27 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.110_00.000
Variable Name
ULCEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
...An ulcer
This could be a stomach, duodenal or peptic ulcer.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ulcer - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ULCYR]
<2,R,D> [goto ULCCOLEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 28 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.120_00.000
Variable Name
ULCYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ULCEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had an ulcer
Question Text
DURING THE PAST 12 MONTHS have you had
... An ulcer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ulcer - past 12 months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [goto ULCCOLEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.120_00.010
Variable Name
ULCCOLEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had Crohn’s
disease or ulcerative colitis?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Crohn's/Colitis - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CANEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.130_00.000
Variable Name
CANEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
...Cancer or a malignancy of any kind?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Cancer - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CANKIND]
<2,R,D> [goto DIBEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.001
Variable Name
CANKIND_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
What kind of cancer was it?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_1
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Monday, August 25, 2014
Page 32 of 97
Skip Instructions
<1-30,R,D> [goto CANAGE_1]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_1]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_1]
Hard Edits
ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.002
Variable Name
CANKIND_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_1=1100, D or (CANAGE_1=R but CANKIND_1 ne R))
Universe-text
Sample adults 18+ who either provided an age for one kind of cancer or didn't know
how old they were when first diagnosed with that kind of cancer or else refused to
provide an age but had not refused to answer CANKIND_1.
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_2
Page 34 of 97
Fill Instructions
Special Instructions "Gray out" whatever option was selected in CANKIND_1 to indicate that that option is
now not available. Make sure that if this option is selected it triggers the error message
that this is an invalid option.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<1-30,R,D>[goto CANAGE_2]
<96> [goto DIBEV]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_2]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_2]
Hard Edits
ERR1_CANKIND_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 35 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.003
Variable Name
CANKIND_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_2=1100, D or (CANAGE_2=R but CANKIND_2 ne R))
Universe-text
Sample adults 18+ who either provided an age for a second kind of cancer or didn't
know how old they were when first diagnosed that kind of cancer or else refused to
provide an age but had not refused to answer CANKIND_2.
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_3
Page 36 of 97
Fill Instructions
Special Instructions "Gray out" whatever options were selected in CANKIND_1 and CANKIND_2 to indicate
that those options are now not available. Make sure that if either of these options are
selected it triggers the error message that this is an invalid option.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<1-30,R,D>[goto CANAGE_3]
<96> [goto DIBEV]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_3]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_3]
Hard Edits
ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.004
Variable Name
CANKIND_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_3=1100, D or (CANAGE_3=R but CANKIND_3 ne R))
Universe-text
Sample adults 18+ who either provided an age for a third kind of cancer or didn't know
how old they were when first diagnosed that kind of cancer or else refused to provide
an age but had not refused to answer CANKIND_3
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Question Type
Pick One - answer list pane
Field Pane Description
More than 3 kinds of cancer
Fill Instructions
Monday, August 25, 2014
Page 38 of 97
Special Instructions "Gray out" whatever options were selected in CANKIND_1, CANKIND_2 and
CANKIND_3 to indicate that those options were already chosen. The only valid options
for this question are 96 and 99.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<95,96> [goto DIBEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_0.001
Variable Name
CANAGE_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_1=1-30,
D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_1 / Fill2: this cancer] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_1
Fill2: if (CANKIND_1 = D,R)
Fill1: if (CANKIND_1 NE D,R)
Fills to be used for CANKIND_1:
bladder cancer if CANKIND_1 = 1
blood cancer if CANKIND_1 = 2
bone cancer if CANKIND_1 = 3
brain cancer if CANKIND_1 = 4
breast cancer if CANKIND_1 = 5
cervical cancer if CANKIND_1 = 6
colon cancer if CANKIND_1 = 7
esophageal cancer if CANKIND_1 = 8
gallbladder cancer if CANKIND_1 = 9
kidney cancer if CANKIND_1 = 10
larynx-windpipe cancer if CANKIND_1 = 11
leukemia if CANKIND_1 = 12
liver cancer if CANKIND_1 = 13
lung cancer if CANKIND_1 = 14
lymphoma if CANKIND_1 = 15
melanoma if CANKIND_1 = 16
mouth/tongue/lip cancer if CANKIND_1 = 17
ovarian cancer if CANKIND_1 = 18
pancreatic cancer if CANKIND_1 = 19
prostate cancer if CANKIND_1 = 20
rectal cancer if CANKIND_1 = 21
skin (non-melanoma) cancer if CANKIND_1 = 22
skin (don't know what kind) cancer if CANKIND_1 = 23
soft tissue (muscle or fat) cancer if CANKIND_1 = 24
stomach cancer if CANKIND_1 = 25
testicular cancer if CANKIND_1 = 26
throat/pharynx cancer if CANKIND_1 = 27
thyroid cancer if CANKIND_1 = 28
uterine cancer if CANKIND_1 = 29other cancer if CANKIND_1 = 30
Special Instructions
Monday, August 25, 2014
Page 40 of 97
Skip Instructions
<1-100, D> goto CANKIND_2
and at CANKIND_1 [goto DIBEV]
and CANKIND_1 NE [goto CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) [goto ERR_ CANAGE_1]
Hard Edits
ERR_ CANAGE_1
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_00.002
Variable Name
CANAGE_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_2 = 130,D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_2/Fill2: this cancer] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_2
Fill1: if (CANKIND_2 NE D,R)
Fill2: if (CANKIND_2 = D,R)
Special Instructions
Skip Instructions
<1-100, D> [goto CANKIND_3]
and at CANKIND_2 [goto DIBEV]
and CANKIND_2 NE [goto CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) [goto ERR_ CANAGE_2]
Hard Edits
ERR_ CANAGE_2
* [Fill2: CANAGE_2] years old is older than your age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Monday, August 25, 2014
Page 41 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_00.003
Variable Name
CANAGE_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_3=1-30,
D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_3/Fill2: this cancer ] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_3
Fill1: if (CANKIND_3 NE D,R)
Fill2: if (CANKIND_3 = D,R)
Special Instructions
Skip Instructions
<1-100, D> [goto CANKIND_4]
and at CANKIND_3 [goto DIBEV]
and CANKIND_3 NE [goto CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) [goto ERR_ CANAGE_3]
Hard Edits
ERR_ CANAGE_3
* [Fill2: CANAGE_3] years old is older than your age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Monday, August 25, 2014
Page 42 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_1_H
Variable Name
H_CANAGE_1
Universe
Universe-text
Question Text
Probe for a specific age. Record a best estimate if that is what the sample adult gives
you.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CANAGE_1, CANAGE_2, CANAGE_3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_00.000
Variable Name
DIBEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other
health professional that you have diabetes or sugar diabetes?]/[Fill2:Have you EVER
been told by a doctor or other health professional that you have diabetes or sugar
diabetes?]
Answer Codes
1. Yes
2. No
3. Borderline
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Diabetes - ever
Fill1: [If SEX=2 (female)]
Fill2: [if SEX ne 2]
Special Instructions ANSWER categories should appear vertically. If DIBEV=3 fill “1” in DIBPRE1
Skip Instructions
<1> [goto DIBAGE]
<2,R,D> [goto DIBPRE1]
<3> [goto INSLN]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV
Monday, August 25, 2014
Page 44 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_H
Variable Name
H_DIBEV
Universe
Universe-text
Question Text
Do not include a doctor's diagnosis of gestational diabetes or diabetes present only
when a woman is pregnant.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DIBEV
DIBAGE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Sample Adult
Monday, August 25, 2014
Page 45 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.165_00.000
Variable Name
DIBPRE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
DIBEV(e)IN('2','7','9')
Universe-text
Sample adults 18+ who were never told they had diabetes, or who refused or said don’t
know to having been told they had diabetes
Question Text
Have you EVER been told by a doctor or other health professional that you have any of
the following: prediabetes, impaired fasting glucose, impaired glucose tolerance,
borderline diabetes, or high blood sugar?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Pre-diabetic symptoms
Fill1: [If SEX=2 (female)]
Fill2: [if SEX ne 2]
Special Instructions If DIBEV=3 fill 1 in DIBPRE1
Skip Instructions
<1> [goto INSLN]
<2,R,D> [goto EPILEP1]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV
Monday, August 25, 2014
Page 46 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.170_00.000
Variable Name
DIBAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy)
Question Text
? [F1]
How old were you when a doctor or other health professional FIRST told you that you
had diabetes or sugar diabetes?
Answer Codes
Question Type
Integer
Field Pane Description
Diabetes - age
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1-100 R,D> [goto INSLN]
If number in DIBAGE greater than person years old (AGE) [goto ERR_ DIBAGE]
Hard Edits
ERR_ DIBAGE
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.
Soft Edits
AssocHelp
H_DIBEV
Monday, August 25, 2014
Page 47 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.180_00.000
Variable Name
INSLN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV(e)='1' or
DIBPRE1(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had prediabetes, impaired fasting glucose,
impaired glucose tolerance, borderline diabetes, or high blood sugar
Question Text
Are you NOW taking insulin?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Insulin - now
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to DIBEV (ACN.160).
Skip Instructions
<1,2,R,D> [goto DIBPILL]
Hard Edits
Soft Edits
AssocHelp
Sample Adult
Monday, August 25, 2014
Page 48 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.000
Variable Name
DIBPILL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV(e)='1' or
DIBPRE1(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had pre-diabetes, impaired fasting glucose,
impaired glucose tolderance, borderline diabetes, or high blood sugar
Question Text
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes
called oral agents or oral hypoglycemic agents.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Diabetic pill
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to DIBEV (ACN.160).
Skip Instructions
<1,2,R,D> [goto EPILEP1]
Hard Edits
Soft Edits
AssocHelp
Sample Adult
Monday, August 25, 2014
Page 49 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.192_00.010
Variable Name
EPILEP1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever been told by a doctor or other health professional that you have a
seizure disorder or epilepsy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Epilepsy
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto EPILEP2]
<2,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.192_00.020
Variable Name
EPILEP2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Question Text
Are you currently taking any medicine to control your seizure disorder or epilepsy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Medicine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPILEP3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.192_00.030
Variable Name
EPILEP3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Question Text
Today is [fill: Current Date]. Think back to last year about the same time. About how
many seizures of any type have you had in the past year?
*Read if necessary: Some people may call it “convulsion,” “fit,” “falling out spell,”
“episode,” “attack,” “drop attack,” “staring spell,” or “out-of-touch.”.
*If the respondent mentions and counts “auras” as seizures accept the response. If a
respondent indicates that he/she has had nothing more than an aura and is unsure
about counting the aura(s), do NOT count auras as seizures.
Answer Codes
0. None
1. One
2. Two or three
3. Between four and ten
4. More than 10
Refused
Don't know
Question Type
Pick one - answer list pane
Field Pane Description
Fill Instructions
Seizures
[fill: Current Date]
Comes from the Long date format:
CDATE_C / FRT.380
Special Instructions [fill: Current Date
Long date format
CDATE_C / FRT.380
Skip Instructions
<0-4,R,D> [goto EPILEP4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.192_00.040
Variable Name
EPILEP4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Question Text
In the past year have you seen a neurologist or epilepsy specialist for your epilepsy or
seizure disorder?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Seen specialist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPILEP5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 53 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.192_00.050
Variable Name
EPILEP5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Question Text
DURING THE PAST 30 DAYS, to what extent has epilepsy or its treatment interfered
with your normal activities like working, school, or socializing with family or friends?
Would you say…
*Read categories below.
Answer Codes
1. Not at all
2. Slightly
3. Moderately
4. Quite a bit
5. Extremely
Refused
Don't know
Question Type
Pick one - answer list pane
Field Pane Description
Effects
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_01.000
Variable Name
AHAYFYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Hay fever?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hay fever
Fill Instructions
Special Instructions "Past 12 mo." as a heading for this question as well as ACN.201_02 - ACN.201_05.
Indent all descriptions beneath the heading.
Skip Instructions
<1,2,R,D> [goto SINYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 55 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_02.000
Variable Name
SINYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Sinusitis?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Sinusitis
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBRCHYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_03.000
Variable Name
CBRCHYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Chronic bronchitis?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Chronic bronchitis
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto KIDWKYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_04.000
Variable Name
KIDWKYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
......Weak or failing kidneys? - Do not include kidney stones, bladder infections or
incontinence.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Weak/failing kidneys
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LIVYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_05.000
Variable Name
LIVYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Any kind of liver condition?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Liver condition
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto JNTSYMP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 59 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.250_00.000
Variable Name
JNTSYMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions refer to your joints. Please do NOT include the back or neck.
DURING THE PAST 30 DAYS, have you had any symptoms of pain, aching, or
stiffness in or around a joint?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Joint pain - past 30 days
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto JMTHP]
<2,R,D> [goto ARTH]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.260_00.000
Variable Name
JMTHP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
(book) A5
Which joints are affected?
* Enter all that apply, separate with commas.
Answer Codes
1. Shoulder-right
2. Shoulder-left
3. Elbow-right
4. Elbow-left
5. Hip-right
6. Hip-left
7. Wrist-right
8. Wrist-left
9. Knee-right
10. Knee-left
11. Ankle-right
12. Ankle-left
13. Toes-right
14. Toes-left
15. Fingers/thumb-right
16. Fingers/thumb-left
17. Other joint not listed
Don't know
Refused
Question Type
Enter All That Apply
Field Pane Description
Joints affected
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1-17,R,D> [goto JNTCHR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 61 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.270_00.000
Variable Name
JNTCHR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
Did your joint symptoms FIRST begin more than 3 months ago?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Symptoms appear 3+ months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to JNTSYMP (ACN.250).
Skip Instructions
<1,2,R,D> [goto JNTHP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.280_00.000
Variable Name
JNTHP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
Have you EVER seen a doctor or other health professional for these
joint symptoms?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever seen doctor/health professional
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to JNTSYMP (ACN.250).
Skip Instructions
<1,2,R,D> [goto ARTH]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.290_00.000
Variable Name
ARTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Have you EVER been told by a doctor or other health professional that you have some
form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Arthritis - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> or JNTSYMP = 1 [goto ARTHLMT]
<2,R,D> and JNTSYMP ne 1 [goto CTSEVER]
Hard Edits
Soft Edits
AssocHelp
H_ARTH
Monday, August 25, 2014
Page 64 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.290_H
Variable Name
H_ARTH
Universe
Universe-text
Question Text
Include the following as arthritis-related conditions:
-
rheumatism, polymyalgia rheumatica
osteoarthritis (not osteoporosis)
tendonitis, bursitis, bunion, tennis elbow
carpal tunnel syndrome, tarsal tunnel syndrome
joint infection, Reiter's syndrome
ankylosing spondylitis; spondylosis
rotator cuff syndrome
connective tissue disease, scleroderma, polymyositis, Raynaud's syndrome
vasculitis
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ARTH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 65 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.295_00.000
Variable Name
ARTHLMT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1'
or ARTH(e)='1')
Universe-text
Sample adults 18+ with joint pain or arthritis
Question Text
? [F1]
Are you now limited in any way in any of your usual activities because of arthritis or joint
symptoms?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Arthritis/joint symptoms - limitations
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to ARTH (ACN.290).
Skip Instructions
<1,2,R,D> [goto CTSEVER]
Hard Edits
Soft Edits
AssocHelp
H_ARTHLMT
Monday, August 25, 2014
Page 66 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.295_H
Variable Name
H_ARTHLMT
Universe
Universe-text
Question Text
We want to know the sample adult's limitation of activities based on his/her condition
while taking any medications or treatments, if any, to counteract or relieve the arthritis
or joint symptoms.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ARTHLMT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 67 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.296_00.010
Variable Name
CTSEVER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you have a
condition affecting the wrist and hand called carpal tunnel syndrome?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
CTS ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CTSYR]
<2,R,D> [goto PAINECK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 68 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.296_00.020
Variable Name
CTSYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CTSEVER='1'
Universe-text
Sample adults 18+ who have ever been told by a doctor or other health professional
that they have carpal tunnel syndrome
Question Text
DURING THE PAST 12 MONTHS, have you had carpal tunnel syndrome?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
CTS past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1> [if DOINGLW2 IN(1,2,4), then goto CTSWKREL; else goto PAINECK]
<2,R,D> [goto PAINECK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 69 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.297_00.010
Variable Name
CTSWKREL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and CTSYR='1'
Universe-text
Sample adults 18+ who are currently employed and had carpal tunnel syndrome in the
past 12 months
Question Text
Have you ever been told by a doctor or other health professional that your carpal tunnel
syndrome was probably work-related?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
CTS work related
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto PAINECK]
<2> [goto CTSWKRL2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 70 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.297_00.020
Variable Name
CTSWKRL2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and CTSYR='1' and CTSWKREL='2'
Universe-text
Sample adults 18+ who are currently employed, had carpal tunnel syndrome in the past
12 months, and were not told by a doctor or other health professional that their carpal
tunnel syndrome was probably work-related
Question Text
Did YOU ever discuss with a doctor or other health professional whether your carpal
tunnel syndrome was probably caused by your work?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Discuss CTS
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PAINECK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 71 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.300_00.000
Variable Name
PAINECK
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
The following questions are about pain you may have experienced in the PAST
THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do
not report aches and pains that are fleeting or minor.
DURING THE PAST THREE MONTHS, did you have
... Neck pain?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Neck pain
Fill Instructions
Special Instructions "Past 3 months" as a heading for this question as well as ACN.310 - ACN.331_02
Indent all of the Field Pane Descriptions beneath the heading.
Skip Instructions
<1,2,R,D> [goto PAINLB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 72 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.300_H
Variable Name
H_PAINECK
Universe
Universe-text
Question Text
Pain is sample adult defined, but must have lasted a whole day or more or have
occurred several (more than 3) times during the past 3 months.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
PAINECK, PAINLB, PAINLEG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 73 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.310_00.000
Variable Name
PAINLB
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if necessary.
DURING THE PAST THREE MONTHS, did you have
... Low back pain?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Low back pain
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PAINLEG]
<2,R,D> [goto PAINFACE]
Hard Edits
Soft Edits
AssocHelp
H_PAINECK
Monday, August 25, 2014
Page 74 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.320_00.000
Variable Name
PAINLEG
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PAINLB(e)=1
Universe-text
Sample adults 18+ with low back pain in the past 3 months
Question Text
? [F1]
Did this pain spread down either leg to areas below the knees?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Pain down leg
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [goto LBPFREQ]
Hard Edits
Soft Edits
AssocHelp
H_PAINECK
Monday, August 25, 2014
Page 75 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.010
Variable Name
LBPFREQ
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PAINLB='1'
Universe-text
Sample adults 18+ who had low back pain in the past 3 months
Question Text
DURING THE PAST THREE MONTHS, how often did you have low back pain? Would
you say...
* Read categories below.
Answer Codes
1. Some days
2. Most days
3. Every day
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
LBP frequency
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto LBPSEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 76 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.020
Variable Name
LBPSEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PAINLB='1'
Universe-text
Sample adults 18+ who had low back pain in the past 3 months
Question Text
Thinking about the last time you had pain, how much pain did you have? Would you
say…
* Read categories below.
Answer Codes
1. A little
2. A lot
3. Somewhere in between a little and a lot
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
LBP severity
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [if DOINGLW IN(1,2,4), then goto LBPWKREL; else goto PAINFACE]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 77 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.030
Variable Name
LBPWKREL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months
Question Text
Have you ever been told by a doctor or other health professional that your low back
pain was probably work-related?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
LBP work related
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto LBPWCCLM]
<2> [goto LBPWKRL2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 78 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.040
Variable Name
LBPWKRL2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1' and LBPWKREL='2'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months and a doctor or other health did not say that the low back pain was probably
work-related
Question Text
Did YOU ever discuss with a doctor or other health professional whether your low back
pain was probably caused by your work?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Discuss LBP
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LBPWCCLM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 79 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.050
Variable Name
LBPWCCLM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months
Question Text
? [F1]
Have you ever filed a workers' compensation claim for your low back pain?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
LBP workers' comp
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto LBPWCBEN]
<2,R,D> [goto LBPWKDAY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 80 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.050_H
Variable Name
H_LBPWCCLM
Universe
Universe-text
Question Text
Workers’ compensation is also known as “workers’ comp” or “workmans’ comp”. It is a
form of insurance, paid for by employers, that provides payment for medical care and
disability for employees who are injured or become ill in the course of their
employment. Filing a workers’ compensation claim means that you reported the
condition to your employer and paperwork was submitted for you to receive insurance
payments for your medical expenses and/or lost wages due to your work-related
condition.
Answer Codes
Question Type
Help screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 81 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.060
Variable Name
LBPWCBEN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1' and LBPWCCLM='1'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months and a workers' compensation claim was filed for the low back pain
Question Text
? [F1]
Have you ever received workers' compensation benefits for your low back pain?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Workers' comp benefits
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LBPWKDAY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 82 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.060_H
Variable Name
H_LBPWKDAY
Universe
Universe-text
Question Text
Workers’ compensation is also known as “workers’ comp” or “workmans’ comp”. When
a workers’ compensation claim is filed and accepted, then the worker receives
insurance payments to cover medical expenses and/or lost wages due to injuries or
illnesses caused by your job.
Answer Codes
Question Type
Help screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 83 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.070
Variable Name
LBPWKDAY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months
Question Text
DURING THE PAST 12 MONTHS, how many full days did you miss from work
because of your low back pain?
* Enter '0' for None.
Answer Codes
0-365
Refused
Don't know
Question Type
Integer
Field Pane Description
Missed work days
Fill Instructions
Special Instructions
Skip Instructions
<0-365,R,D> [goto LBPCHJOB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 84 of 97
Module
16
Section Name
Adult Socio-Demographic Background
Part
Question ID
ACN.325_00.080
Variable Name
LBPCHJOB
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DOINGLW2
IN('1','2','4') and PAINLB='1'
Universe-text
Sample adults 18+ who are currently employed and had low back pain in the past 3
months
Question Text
DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major
change in your work activities, such as taking on lighter duties, because of your low
back pain?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Change in work
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PAINFACE]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 85 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.331_01.000
Variable Name
PAINFACE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST THREE MONTHS, did you have
... Facial ache or pain in the jaw muscles or the joint in front of the ear?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Jaw pain
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AMIGR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 86 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.331_02.000
Variable Name
AMIGR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if neccesary:
DURING THE PAST THREE MONTHS, did you have
...Severe headache or migraine?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Severe headache/migraine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ACOLD2W]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 87 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.350_00.000
Variable Name
ACOLD2W
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about your recent health DURING THE LAST 2 WEEKS.
Did you have a head cold or chest cold that started DURING THE LAST 2 WEEKS?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Head/chest cold past 2 weeks
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AINTIL2W]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 88 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.360_00.000
Variable Name
AINTIL2W
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Did you have a stomach or intestinal illness with vomiting or diarrhea that started
DURING THE LAST TWO WEEKS?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stomach problem - 2 weeks
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if SEX=2 and AGE 18-49 [goto PREGNOW];
else if SEX=1 or AGE >49 [goto HRAIDNOW]
Hard Edits
Soft Edits
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Monday, August 25, 2014
Page 89 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.370_00.000
Variable Name
PREGNOW
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2'
Universe-text
Female sample adults 18-49 years of age
Question Text
Are you currently pregnant?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Currently pregnant
Fill Instructions
Special Instructions
Skip Instructions
<1> if INTERVIEW_MONTH=4,5,6,7 (April-July) [goto PREGFLYR];
else [goto HRAIDNOW]
[goto HRAIDNOW]
<2,D> [goto PREGFLYR]
Hard Edits
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Monday, August 25, 2014
Page 90 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.370_00.010
Variable Name
PREGFLYR
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and PREGNOW(e) IN('2','9')
or (PREGNOW(e)='1' and INTERVIEW_MONTH(e) IN ('04','05','06','07'))
Universe-text
Female sample adults 18-49 years of age who are not currently pregnant or who don't
know if they are currently pregnant and interviewed April - July
Question Text
[fill1: Were you pregnant any time since August 1st, [fill: LAST YEAR]?/Were you
pregnant any time from August [fill: LAST YEAR] through March [fill: CURYEAR]?/Were
you pregnant any time since August 1st, [fill: CURYEAR]?]
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
IF INTERVIEW_MONTH=1,2,3 (January-March) THEN
fill: “Were you pregnant any time since August 1st, [fill: LAST YEAR]?”
ELSE IF INTERVIEW_MONTH=4,5,6,7 (April-July) THEN
fill: “Were you pregnant any time from August [fill: LAST YEAR] through March [fill:
CURYEAR]?”
ELSE
fill: “Were you pregnant any time since August 1st, [fill: CURYEAR]?”
Special Instructions
Skip Instructions
<1,2,R,D> [goto HRAIDNOW]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 91 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.400_00.000
Variable Name
HRAIDNOW
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about your hearing, vision, and teeth.
Do you now use a hearing aid(s)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hearing aid - now
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHEARST1]
<2,R,D> [goto HRAIDEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 92 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.410_00.000
Variable Name
HRAIDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HRAIDNOW(e)
IN('2','7','9')
Universe-text
Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use
a hearing aid
Question Text
Have you ever used a hearing aid(s) in the past?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hearing aid - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHEARST1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 93 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.420_00.000
Variable Name
AHEARST1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
WITHOUT the use of hearing aids or other listening devices, is your hearing excellent,
good, a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf?
Answer Codes
1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Hearing status
Fill Instructions
Special Instructions
Skip Instructions
<1-6,R,D> [goto AVISION]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 94 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.430_00.000
Variable Name
AVISION
Universe
HHSTAT4='S' and (AGE GE '018'
Universe-text
Sample adults 18+
Question Text
Do you have any trouble seeing, even when wearing glasses or contact lenses?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Trouble seeing
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ABLIND]
<2,R,D> [goto LUPPRT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 95 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.000
Variable Name
ABLIND
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AVISION(e)='1'
Universe-text
Sample adults 18+ who have trouble seeing even when wearing glasses/contact lenses
Question Text
Are you blind or unable to see at all?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Blind
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [goto LUPPRT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 96 of 97
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.451_00.000
Variable Name
LUPPRT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you lost all of your upper and lower natural (permanent) teeth?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Lost all teeth
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 97 of 97
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Health Status and Limitation of Activities
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.040
Variable Name
WKDAYR
Universe
HHSTAT4='S' and AGE ge '18' and (DOINGLW2 = '1' ,'2', '4' or WRKLYR2 = '1') and
(EVERWRK ne 'No', 'Refused', or 'Don't know')
Universe-text
Sample adults 18+ who worked or had a job or business with or without pay in the last
week or who had a job or business in the past 12 months
Question Text
During the PAST 12 MONTHS ABOUT how many days did you miss work at a job or
business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Work days missed
Fill Instructions
Special Instructions
Skip Instructions
<0-366,R,D> [goto BEDDAYR]
<120-366> [goto ERR_WKDAYR]
Hard Edits
Soft Edits
ERR_WKDAYR
* [Fill: WKDAYR] is an unusually large number.
* Please verify.
AssocHelp
H_WKDAYR
Monday, August 25, 2014
Page 1 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.040_H
Variable Name
H_WKDAYR
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
WKDAYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.050
Variable Name
BEDDAYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN('997','999'))
Universe-text
Sample adults 18+
Question Text
During the PAST 12 MONTHS ABOUT how many days did illness or injury keep you in
bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Days in bed
Fill Instructions
Special Instructions
Skip Instructions
<0-366,R,D> [goto AHSTATYR]
<120-366> [goto ERR_BEDDAYR]
Hard Edits
Soft Edits
ERR_BEDDAYR
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.
AssocHelp
H_BEDDAYR
Monday, August 25, 2014
Page 3 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.050_H
Variable Name
H_BEDDAYR
Universe
Universe-text
Question Text
Days in bed are any days during which the sample adult stayed in bed MORE than half
of the day because of illness or injury. "More than half of the day" is defined as more
than half of the hours that the sample adult is usually awake. Count as days in bed all
days a sample adult spent as an overnight patient in a hospital, sanitarium, nursing
home, etc., whether or not the patient was actually lying in bed, even if there was no
illness or injury.
A bed is anything used for lying down or sleeping, including a sofa, cot or mattress.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
BEDDAYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.060
Variable Name
AHSTATYR
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
Compared with 12 MONTHS AGO, would you say your health is better, worse, or about
the same?
Answer Codes
1. Better
2. Worse
3. About the same
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Health status
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1-3,R,D> [goto SPECEQ (AHS.070)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.070
Variable Name
SPECEQ
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
Do you now have any health problem that requires you to use special equipment, such
as a cane, a wheelchair, a special bed, or a special telephone?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Special equipment
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1,2,R,D> [goto FLWALK_1]
Hard Edits
Soft Edits
AssocHelp
H_SPECEQ
Monday, August 25, 2014
Page 6 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.070_H
Variable Name
H_SPECEQ
Universe
Universe-text
Question Text
"Problem" is the sample adult's perception of a departure from physical, mental or
emotional well-being. This incudes specific health problems, such as a disease or
condition, a missing extremity or organ, or any type of impairment. It also includes
more vague disorders not always thought of as health related problems or illnesses
such as alcoholism, drug dependency or reaction, senility, depression, retardation, etc.
"Special Equipment" is any device, tool, utensil, instrument, implement, etc., used as an
aid in performing an activity because of a physical, mental or emotional problem. This
incudes the use of adult "diapers" for incontinence. For example: a spoon is not
normally considered as "special equipment"; however, a uniquely designed or
functioning one used for eating by a person because of
physical, mental, or emotional problems is considered "special equipment."
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
SPECEQ
Skip Instructions
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Monday, August 25, 2014
Page 7 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.080
Variable Name
FLWALK_1
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
The next questions ask about difficulties you may have doing certain activities because
of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or
emotional problem or illness [Fill1:(not including pregnancy) ].
Answer Codes
1. Enter 1 to continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
Fill1: If SEX=2 (female), then display the following text: (not including pregnancy)
Special Instructions
Skip Instructions
<1> [goto FLWALK]
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Monday, August 25, 2014
Page 8 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_1
Variable Name
FLWALK
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
By yourself, and without using any special equipment, how difficult is it for you to
...Walk a quarter of a mile - about 3 city blocks?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Walk a quarter of a mile
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLCLIMB]
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H_FLWALK
Monday, August 25, 2014
Page 9 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_1_H
Variable Name
H_FLWALK
Universe
Universe-text
Question Text
Difficult is respondent defined.
"Problem" is the sample adult's perception of a departure from physical, mental or
emotional well-being. This includes specific health problems, such as a disease or
condition, a missing extremity or organ, or any type of impairment. It also includes
more vague disorders not always thought of as health related problems or illnesses
such as alcoholism, drug dependency or reaction, senility, depression, retardation, etc.
"Special Equipment" is any device, tool, utensil, instrument, implement, etc., used as an
aid in performing an activity because of a physical, mental or emotional problem. This
includes the use of adult "diapers" for incontinence. For example: a spoon is not
normally considered as "special equipment"; however, a uniquely designed or
functioning one used for eating by a person because of physical, mental, or emotional
problems is considered "special equipment."
"Difficult" is respondent defined.
If the sample adult gives an answer which does not match the categories
on the flashcard, reread the question emphasizing the wording of the
answer categories.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
FLWALK
FLCLIMB
FLSTAND
FLSIT
FLSTOOP
FLREACH
FLGRASP
FLCARRY
FLPUSH
FLSHOP
FLSOCL
FLRELAX
Skip Instructions
Monday, August 25, 2014
Page 10 of 100
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Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_2
Variable Name
FLCLIMB
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Walk up 10 steps without resting?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Walk up 10 steps
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSTAND]
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H_FLWALK
Monday, August 25, 2014
Page 11 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_3
Variable Name
FLSTAND
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Stand or be on your feet for about 2 hours?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Stand for 2 hours
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSIT]
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H_FLWALK
Monday, August 25, 2014
Page 12 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_4
Variable Name
FLSIT
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Sit for about 2 hours?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Sit for 2 hours
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSTOOP]
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H_FLWALK
Monday, August 25, 2014
Page 13 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_5
Variable Name
FLSTOOP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Stoop, bend, or kneel?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Stoop, bend or kneel
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLREACH]
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H_FLWALK
Monday, August 25, 2014
Page 14 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_6
Variable Name
FLREACH
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Reach up over your head?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Reach up overhead
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLGRASP]
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H_FLWALK
Monday, August 25, 2014
Page 15 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_1
Variable Name
FLGRASP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Use your fingers to grasp or handle small objects?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Grasp small objects
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLCARRY]
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H_FLWALK
Monday, August 25, 2014
Page 16 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_2
Variable Name
FLCARRY
Universe
HHSTAT4 = 'S'and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Lift or carry 10 pounds
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLPUSH]
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H_FLWALK
Monday, August 25, 2014
Page 17 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_3
Variable Name
FLPUSH
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Push or pull large objects like a living room chair?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Push or pull large objects
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSHOP]
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H_FLWALK
Monday, August 25, 2014
Page 18 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_1
Variable Name
FLSHOP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Go out to things like shopping, movies, or sporting events?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Go out to things
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSOCL]
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H_FLWALK
Monday, August 25, 2014
Page 19 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_2
Variable Name
FLSOCL
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Participate in social activities such as visiting friends, attending clubs and meetings,
going to parties?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Social activities
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLRELAX]
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H_FLWALK
Monday, August 25, 2014
Page 20 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_3
Variable Name
FLRELAX
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to
music)?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Relax at home
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or
FLSTOOP= 1-4 or FLREACH= 1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH=
1-4 or FLSHOP= 1-4 or FLSOCL= 1-4> [goto AFLHCA]
Else [goto SMKEV] (next section)
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H_FLWALK
Monday, August 25, 2014
Page 21 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.200
Variable Name
AFLHCA
Universe
HHSTAT4 = 'S' and AGE GE 18 and (FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND=
1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or FLREACH= 1-4 or FLGRASP= 1-4 or
FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-4 or FLRELAX = 1-4)
Universe-text
Sample adults 18+ who, without using special equipment, have at least a little difficulty
walking a quarter mile; walking up 10 steps without resting; standing/being on feet for
about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over
head; using fingers to grasp/handle small objects; lifting/carrying 10 pounds;
pushing/pulling large objects;going out for things (shopping/movies); participating in
social activities; or relaxing at home (reading/sewing).
Question Text
(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1,
condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these
activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.
Answer Codes
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (for example, asthma and emphysema)
12. Cancer
13. Birth defect
14. Intellectual disability also known as mental retardation
15. Other developmental problem (for example cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
--------------------------------------------------------------------[*/On bottom of Flashcard only:
"Other impairment/problem" /*]
--------------------------------------------------------------------------------------------------- [*/ q4 or
2005 fix to add a divider line between 18 & 19 /*]
19. Missing limbs (fingers, toes or digits), amputee
20. Kidney, bladder or renal problems
21. Circulation problems (including blood clots)
22. Benign Tumors, cysts
23. Fibromyalgia, lupus
24. Osteoporosis, tendinitis
25. Epilepsy, seizures
Monday, August 25, 2014
Page 22 of 100
26. Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27. Polio(myelitis), paralysis, para/quadriplegia
28. Parkinson’s disease, other tremors
29. Other nerve damage, including carpal tunnel syndrome
30. Hernia
31. Ulcer
32. Varicose veins, hemorrhoids
33. Thyroid problems, Grave’s disease, gout
34. Knee problems (not arthritis (03), not joint injury(05))
35. Migraine headaches (not just headaches)
90. Other impairment/problem (Specify one)
91. Other impairment/problem (Specify one)
Refused
Don’t know/not sure
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Condition numbers
Fill1 = [if the number of conditions indicated in questions AHS.091_1 - AHS.171_3 as
having at least a little bit of difficulty (i.e. answers are 1-4) is less than or equal to 3]
Fill2 = [if the number of conditions indicated in questions AHS.091_1 - AHS.171_3 as
having at least a little bit of difficulty (i.e. answers are 1-4) is greater than 3]
Special Instructions The fill to be applied in the question text for Fill 1 is conditional on how many of the
responses to questions AHS.091_1 through AHS.171_3 were either 1,2,3 or 4 (I.e. the
respondent had a least a little difficulty carrying out the particular activity/action). If only
one of these questions has an answer that meets the criteria (I.e. 1-4), then the
question text is "What condition or health problem causes you to have difficulty with
[condition 1]?". If only 2 questions had answers in the 1-4 range, the question text is
"What condition or health problem causes you to have difficulty with [condition 1] or
[condition 2]?". If 3 questions had such answers, use the question text provided.
Use the following phrases to fill in the question text when the conditions for Fill 1 apply:
FLWALK: walking a quarter of a mile
FLCLIMB: walking up 10 steps
FLSTAND: standing for 2 hours
FLSIT: sitting for 2 hours
FLSTOOP: stooping, bending or kneeling
FLREACH: reaching up overhead
FLGRASP: grasping or handling small objects
FLCARRY: lifting or carrying 10 pounds
FLPUSH: pushing or pulling large objects
FLSHOP: going out for things
FLSOCL: participating in social activities
FLRELAX: relaxing at home
Skip Instructions
[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14NAHCL35N], in numerical order
<13> store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
<90> [goto AFLHCA_S1]
<91> [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
[goto SMKEV (next section)]
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Monday, August 25, 2014
Page 23 of 100
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H_FLWALK
Module
17
Section Name
Part
Question ID
AHS.200_H
Variable Name
H_AFLHCA
Universe
Universe-text
Question Text
The terms "conditions" and "health problems" are respondent defined.
Do not read the precoded categories to the respondent.
Enter "90" or "91" if the respondent mentions a condition or health problem not listed
and then specify the condition exactly as the respondent states it.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AFLHCA
Skip Instructions
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Monday, August 25, 2014
Page 24 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.201_90
Variable Name
AFLHCA_S1
Universe
HHSTAT4 = 'S' and AGE GE 18 and 90 selected in AFLHCA
Universe-text
Sample adults 18+ whose difficulties performing activities listed in FLWALK through
FLRELAX is due to at least one condition not listed in AFLHCA
Question Text
* Enter other impairment/problem.
Answer Codes
Question Type
Text
Field Pane Description
Specify
Fill Instructions
Special Instructions */ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (1) [
Skip Instructions
] /* for either Q4 or 2005 fix
<50 chars> [goto AHCL90N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14NAHCL35N], in numerical order, as specified in AFLHCA
Hard Edits
$ You should enter something specific.
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Monday, August 25, 2014
Page 25 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.201_91
Variable Name
AFLHCA_S2
Universe
HHSTAT4 = 'S' and AGE GE 18 and 91 selected in AFLHCA
Universe-text
Sample adults 18+ whose difficulty performing activities listed in FLWALK through
FLRELAX is due to more than one condition that is not listed in AFLHCA
Question Text
* Enter other impairment/problem.
Answer Codes
Question Type
Text
Field Pane Description
Specify
Fill Instructions
Special Instructions */ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (2) [
Skip Instructions
] /* for either Q4 or 2005 fix
<50 chars> [goto AHCL91N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
*/ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (2) [
] /* for either Q4 or 2005 fix
Hard Edits
$ You should enter something specific.
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Monday, August 25, 2014
Page 26 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.300_1
Variable Name
AHCL01N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 1
Universe-text
Sample adults 18+ who had difficulty due to a vision problem or problem seeing
Question Text
1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL01T]
[store "R" in AHCL01T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL01T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
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Monday, August 25, 2014
Page 27 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.300_2
Variable Name
AHCL01T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL01N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with vision problem or problem seeing.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [ goto ERR2_AHCL01T]
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T
Hard Edits
ERR1_AHCL01T
*Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL01T
* "6" not selectable.
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Monday, August 25, 2014
Page 28 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.301_1
Variable Name
AHCL02N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 2
Universe-text
Sample adults 18+ who had difficulty due to a hearing problem
Question Text
1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL02T]
[store "R" in AHCL02T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL02T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
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Monday, August 25, 2014
Page 29 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.301_2
Variable Name
AHCL02T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL02N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hearing problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL02T]
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T
Hard Edits
ERR1_AHCL02T
* Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL02T
* "6" not selectable.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.302_1
Variable Name
AHCL03N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 3
Universe-text
Sample adults 18+ who had difficulty due to arthritis or rheumatism
Question Text
1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL03T]
[store "R" in AHCL03T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL03T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.302_2
Variable Name
AHCL03T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL03N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with arthritis or rheumatism.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL03T]
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T
Hard Edits
ERR_AHCL03T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.303_1
Variable Name
AHCL04N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 4
Universe-text
Sample adults 18+ who had difficulty due to a back or neck problem
Question Text
1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL04T]
[store "R" in AHCL04T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL04T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.303_2
Variable Name
AHCL04T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL04N= 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with back or neck problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL04T]
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T
Hard Edits
ERR_AHCL04T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.304_1
Variable Name
AHCL05N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 5
Universe-text
Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
Question Text
1 of 2
How long have you had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone, or joint injury.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL05T]
[store "R" in AHCL05T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL05T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 35 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.304_2
Variable Name
AHCL05T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL05N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with fracture, bone, or joint injury.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL05T]
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T
Hard Edits
ERR_AHCL05T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.305_1
Variable Name
AHCL06N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 6
Universe-text
Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or
joint injury
Question Text
1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
Fill: [if condition 5 is selected at AFLHCA]
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL06T]
[store "R" in AHCL06T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL06T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.305_2
Variable Name
AHCL06T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL06N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with (fill: other) injury.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Integer
Field Pane Description
Fill Instructions
Time period
Fill: [if condition 5 is selected at AFLHCA]
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL06T]
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T
Hard Edits
ERR_AHCL06T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.306_1
Variable Name
AHCL07N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 7
Universe-text
Sample adults 18+ who had difficulty due to a heart problem
Question Text
1 of 2
How long have you had a heart problem?
* Enter number for time with a heart problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL07T]
[store "R" in AHCL07T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL07T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.306_2
Variable Name
AHCL07T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL07N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with heart problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Integer
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL07T]
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] goto
ERR1_AHCL07T
Hard Edits
ERR_AHCL07T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.307_1
Variable Name
AHCL08N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 8
Universe-text
Sample adults 18+ who had difficulty due to a stroke problem
Question Text
1 of 2
How long have you had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL08T]
[store "R" in AHCL08T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL08T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 41 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.307_2
Variable Name
AHCL08T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL08N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with stroke problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL08T]
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] goto
ERR1_AHCL08T
Hard Edits
ERR_AHCL08T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.308_1
Variable Name
AHCL09N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 9
Universe-text
Sample adults 18+ who had difficulty due to hypertension or high blood pressure
Question Text
1 of 2
How long have you had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL09T]
[store "R" in AHCL09T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL09T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.308_2
Variable Name
AHCL09T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL09N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hypertension or high blood pressure.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL09T]
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T
Hard Edits
ERR_AHCL09T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.309_1
Variable Name
AHCL10N
Universe
HHSTAT4 = 'S'and AGE GE 18 and AFLHCA = 10
Universe-text
Sample adults 18+ who had difficulty due to diabetes
Question Text
1 of 2
How long have you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL10T]
[store "R" in AHCL10T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL10T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 45 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.309_2
Variable Name
AHCL10T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL10N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with diabetes.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T
Hard Edits
ERR_AHCL10T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 46 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.310_1
Variable Name
AHCL11N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 11
Universe-text
Sample adults 18+ who had difficulty due to a lung or breathing problem
Question Text
1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL11T]
[store "R" in AHCL11T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL11T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 47 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.310_2
Variable Name
AHCL11T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL11N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and
emphysema).
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL11T]
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T
Hard Edits
ERR_AHCL11T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 48 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.311_1
Variable Name
AHCL12N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 12
Universe-text
Sample adults 18+ who had difficulty due to cancer
Question Text
1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL12T]
[store "R" in AHCL12T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL12T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 49 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.311_2
Variable Name
AHCL12T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL12N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with cancer.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL12T]
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T
Hard Edits
ERR_AHCL12T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.312_1
Variable Name
AHCL13N
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Fill Instructions
Special Instructions Storage variable for follow up to choice # 13 (birth defect) in AFLHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.312_2
Variable Name
AHCL13T
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Time period
Fill Instructions
Special Instructions Storage variable for follow up to choice # 13 (birth defect) in AFLHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.313_1
Variable Name
AHCL14N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 14
Universe-text
Sample adults 18+ who had difficulty due to mental retardation
Question Text
1 of 2
How long have you had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL14T]
[store "R" in AHCL14T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL14T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 53 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.313_2
Variable Name
AHCL14T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL14N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with intellectual disability/mental retardation.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL14T]
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T
Hard Edits
ERR_AHCL14T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.314_1
Variable Name
AHCL15N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 15
Universe-text
Sample adults 18+ who had difficulty due to a developmental problem
Question Text
1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL15T]
[store "R" in AHCL15T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL15T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 55 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.314_2
Variable Name
AHCL15T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL15N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with developmental problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL15T]
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T
Hard Edits
ERR_AHCL15T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.315_1
Variable Name
AHCL16N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 16
Universe-text
Sample adults 18+ who had difficulty due to senility
Question Text
1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL16T]
[store "R" in AHCL16T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL16T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.315_2
Variable Name
AHCL16T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL16N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with senility.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL16T]
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T
Hard Edits
ERR_AHCL16T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.316_1
Variable Name
AHCL17N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 17
Universe-text
Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional
problem
Question Text
1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL17T]
[store "R" in AHCL17T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL17T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 59 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.316_2
Variable Name
AHCL17T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL17N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL17T]
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T
Hard Edits
ERR_AHCL17T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.317_1
Variable Name
AHCL18N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 18
Universe-text
Sample adults 18+ who had difficulty due to a weight problem
Question Text
1 of 2
How long have you had a weight problem?
* Enter number for time with a weight problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL18T]
[store "R" in AHCL18T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL18T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 61 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.317_2
Variable Name
AHCL18T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL18N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with weight problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL18T]
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] goto
ERR1_AHCL18T
Hard Edits
ERR_AHCL18T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.318_1
Variable Name
AHCL19N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 19
Universe-text
Sample adults 18+ who had difficulty due to a missing limb
Question Text
1 of 2
How long have you had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL19T]
[store "R" in AHCL19T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL19T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.318_2
Variable Name
AHCL19T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL19N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with missing limb.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL19T]
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] goto
ERR1_AHCL19T
Hard Edits
ERR_AHCL19T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.319_1
Variable Name
AHCL20N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 20
Universe-text
Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
Question Text
1 of 2
How long have you had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL20T]
[store "R" in AHCL20T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL20T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 65 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.319_2
Variable Name
AHCL20T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL20N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with kidney, bladder or renal problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL20T]
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T
Hard Edits
ERR_AHCL20T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 66 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.320_1
Variable Name
AHCL21N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 21
Universe-text
Sample adults 18+ who had difficulty due to a circulation problem
Question Text
1 of 2
How long have you had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL21T]
[store "R" in AHCL21T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL21T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 67 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.320_2
Variable Name
AHCL21T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL21N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with circulation problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL21T]
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T
Hard Edits
ERR_AHCL21T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 68 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.321_1
Variable Name
AHCL22N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 22
Universe-text
Sample adults 18+ who had difficulty due to benign tumors or cysts
Question Text
1 of 2
How long have you had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL22T]
[store "R" in AHCL22T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL22T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 69 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.321_2
Variable Name
AHCL22T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL22N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with benign tumors or cysts.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL22T]
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T
Hard Edits
ERR_AHCL22T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 70 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.322_1
Variable Name
AHCL23N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 23
Universe-text
Sample adults 18+ who had difficulty due to fibromyalgia or lupus
Question Text
1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL23T]
[store "R" in AHCL23T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL23T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 71 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.322_2
Variable Name
AHCL23T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL23N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with fibromyalgia or lupus.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T
Hard Edits
ERR_AHCL23T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 72 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.323_1
Variable Name
AHCL24N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 24
Universe-text
Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
Question Text
1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL24T]
[store "R" in AHCL24T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL24T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 73 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.323_2
Variable Name
AHCL24T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL24N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with osteoporosis or tendinitis.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T
Hard Edits
ERR_AHCL24T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 74 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.324_1
Variable Name
AHCL25N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 25
Universe-text
Sample adults 18+ who had difficulty due to epilepsy or seizures
Question Text
1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL25T]
[store "R" in AHCL25T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL25T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 75 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.324_2
Variable Name
AHCL25T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL25N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with epilepsy or seizures.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T
Hard Edits
ERR_AHCL25T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 76 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.325_1
Variable Name
AHCL26N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 26
Universe-text
Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
Question Text
1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for fime with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL26T]
[store "R" in AHCL26T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL26T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 77 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.325_2
Variable Name
AHCL26T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL26N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T
Hard Edits
ERR_AHCL26T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 78 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.326_1
Variable Name
AHCL27N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 27
Universe-text
Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or
para/quadriplegia
Question Text
1 of 2
How long have you had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis), paralysis or para/quadriplegia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL27T]
[store "R" in AHCL27T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL27T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 79 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.326_2
Variable Name
AHCL27T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL27N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T
Hard Edits
ERR_AHCL27T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 80 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.327_1
Variable Name
AHCL28N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 28
Universe-text
Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
Question Text
1 of 2
How long have you had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL28T]
[store "R" in AHCL28T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL28T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 81 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.327_2
Variable Name
AHCL28T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL28N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with Parkinson's disease or tremors.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] goto
ERR1_AHCL28T
Hard Edits
ERR_AHCL28T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 82 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.328_1
Variable Name
AHCL29N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 29
Universe-text
Sample adults 18+ who had difficulty due to nerve damage
Question Text
1 of 2
How long have you had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerver damage (including carpal tunnel syndrome).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL29T]
[store "R" in AHCL29T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL29T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 83 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.328_2
Variable Name
AHCL29T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL29N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with nerve damage.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] goto
ERR1_AHCL29T
Hard Edits
ERR_AHCL29T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 84 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.329_1
Variable Name
AHCL30N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 30
Universe-text
Sample adults 18+ who had difficulty due to a hernia
Question Text
1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL30T]
[store "R" in AHCL30T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL30T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 85 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.329_2
Variable Name
AHCL30T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL30N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hernia.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T
Hard Edits
ERR_AHCL30T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 86 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.330_1
Variable Name
AHCL31N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 31
Universe-text
Sample adults 18+ who had difficulty due to an ulcer
Question Text
1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL31T]
[store "R" in AHCL31T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL31T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 87 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.330_2
Variable Name
AHCL31T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL31N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with ulcer.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T
Hard Edits
ERR_AHCL31T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 88 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.331_1
Variable Name
AHCL32N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 32
Universe-text
Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
Question Text
1 of 2
How long have you had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL32T]
[store "R" in AHCL32T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL32T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 89 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.331_2
Variable Name
AHCL32T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL32N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T
Hard Edits
ERR_AHCL32T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 90 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.332_1
Variable Name
AHCL33N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 33
Universe-text
Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
Question Text
1 of 2
How long have you had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL33T]
[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 91 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.332_2
Variable Name
AHCL33T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL33N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T
Hard Edits
ERR_AHCL33T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 92 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.333_1
Variable Name
AHCL34N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 34
Universe-text
Sample adults 18+ who had difficulty due to a knee problem
Question Text
1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL34T]
[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 93 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.333_2
Variable Name
AHCL34T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL34N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with knee problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T
Hard Edits
ERR1_AHCL34T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 94 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.334_1
Variable Name
AHCL35N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 35
Universe-text
Sample adults 18+ who had difficulty due to migraine headaches
Question Text
1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL35T]
[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 95 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.334_2
Variable Name
AHCL35T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL35N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with migraine headaches.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T
Hard Edits
ERR1_AHCL35T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 96 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.335_1
Variable Name
AHCL90N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 90
Universe-text
Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
Question Text
1 of 2
How long have you had {problem in AFLHCA80}?
* Enter number for time with {problem in AFLHCA80}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL90T]
[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 97 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.335_2
Variable Name
AHCL90T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL36N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with {problem in AFLHCA80}.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T
Hard Edits
ERR_AHCL90T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 98 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.336_1
Variable Name
AHCL91N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 91
Universe-text
Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
Question Text
1 of 2
How long have you had {problem in AFLHCA81}?
* Enter number for time with {problem in AFLHCA81}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL36T]
[store "R" in AHCL36T] [goto SMKEV (next section)]
<96>[store "6" in AHCL36T] [goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 99 of 100
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.336_2
Variable Name
AHCL91T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL37N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with {problem in AFLHCA81}.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL37T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T
Hard Edits
ERR_AHCL91T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 100 of 100
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Health Behavior
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.010
Variable Name
SMKEV
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever smoked 100 cigarettes
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SMKREG]
<2> [goto SMKANY]
[goto VIGNO]
[goto SMKANY]
Hard Edits
Soft Edits
AssocHelp
H_SMKEV
Monday, August 25, 2014
Page 1 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.010_H
Variable Name
H_SMKEV
Universe
Universe-text
Question Text
A cigarette is anything the sample adult reports except cigars of any kind or marijuana.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.020
Variable Name
SMKREG
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKEV = 1
Universe-text
Sample adults 18+ who ever smoked 100 cigarettes
Question Text
? [F1]
How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.
Answer Codes
Question Type
Integer
Field Pane Description
Age started smoking
Fill Instructions
Special Instructions
Skip Instructions
<6-95,96,R,D> [goto SMKNOW]
[If SMKREG gt AGE and SMKREG ne <96>, goto ERR_SMKREG
Hard Edits
ERR_SMKREG
* Starting age exceeded current age.
* Please correct.
Soft Edits
AssocHelp
H_SMKREG
Monday, August 25, 2014
Page 3 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.020_H
Variable Name
H_SMKREG
Universe
Universe-text
Question Text
Always probe for an exact age. If the sample adult reports a range or interval, assist
the sample adult in making an estimate by probing. For example, you might ask "Could
you give me a more exact age?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKREG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.030
Variable Name
SMKNOW
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKEV = 1
Universe-text
Sample adults 18+ who ever smoked 100 cigarettes
Question Text
? [F1]
Do you NOW smoke cigarettes every day, some days or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Now Smoke
Fill Instructions
Special Instructions Add answer name to the right of input.
Skip Instructions
<1>[goto CIGSDA1]
<2>[goto CIGDAMO]
<3>[goto SMKQTNO]
[goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
H_SMKNOW
Monday, August 25, 2014
Page 5 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.030_H
Variable Name
H_SMKNOW
Universe
Universe-text
Question Text
If the sample adult gives an answer which does not match the categories read in the
question, reread the question emphasizing the wording of the answer categories.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKNOW
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.040_1
Variable Name
SMKQTNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKNOW= 3
Universe-text
Sample adults 18+ who quit smoking
Question Text
? [F1]
1 of 2
How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 or more.
Answer Codes
Question Type
Multi Part
Field Pane Description
Number
Fill Instructions
Special Instructions "Time since quit smoking" as a header for this question and AHB.040_2 (SMKQTTP).
Skip Instructions
<1-95> [goto SMKQTTP]
[goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
H_SMKQT
Monday, August 25, 2014
Page 7 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.040_1_H
Variable Name
H_SMKQT
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKQTNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.040_2
Variable Name
SMKQTTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKQTNO = 1-95
Universe-text
Sample adults 18+ who quit smoking
Question Text
2 of 2
* Enter time period for time since quit smoking.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Refused
Don't know
Question Type
Multi Part
Field Pane Description
Time period
Fill Instructions
Special Instructions Flag when ERR2_SMKQTTP is triggered. Place answer box to the right of that for
AHB.040_1 (SMKQTNO). Show answer name on the right.
Skip Instructions
<1-4> [goto VIGNO]
<4> [if SMKQTNO gt (AGE - <15>), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP.
Hard Edits
ERR2_SMKQTTP
* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current
age ([Fill3: AGE]).
* Please correct.
Soft Edits
ERR1_SMKQTTP
* Respondent quit smoking before age 15?
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 9 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.050
Variable Name
CIGSDA1
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKNOW = 1
Universe-text
Sample adults 18+ who are current every day smokers
Question Text
? [F1]
On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.
Answer Codes
Question Type
Integer
Field Pane Description
Average number of cigarettes daily
Fill Instructions
Special Instructions "Every day smokers" as a header.
Skip Instructions
<1-95,D,R> [goto CIGQTYR]
Hard Edits
Soft Edits
AssocHelp
H_CIGSDA1
Monday, August 25, 2014
Page 10 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.050_H
Variable Name
H_CIGSDA1
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
If the response is given in packs rather than as a number of cigarettes, multiply the
number of packs by 20, verify the result with the sample adult and enter the number of
cigarettes per day.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGSDA1
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.060
Variable Name
CIGDAMO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKNOW = 2
Universe-text
Sample adults 18+ who are current some day smokers
Question Text
? [F1]
On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Number of days smoked
Fill Instructions
Special Instructions "Some day smokers - past 30 days" as a header for this question and AHB.070
Skip Instructions
<0>[goto CIGQTYR]
<1-30,R,D> [goto CIGSDA2]
Hard Edits
Soft Edits
AssocHelp
H_CIGDAMO
Monday, August 25, 2014
Page 12 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.060_H
Variable Name
H_CIGDAMO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Asociated Screens:
CIGDAMO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.070
Variable Name
CIGSDA2
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and [ CIGDAMO=130,D,R) ]
Universe-text
Sample adults 18+ who are current some day smokers
Question Text
? [F1]
On the average, when you smoked during the PAST 30 DAYS, about how many
cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.
Answer Codes
Question Type
Integer
Field Pane Description
Average number of cigarettes on days smoked
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.060
(CIGDAMO).
Skip Instructions
<1-95,D,R> [goto CIGQTYR]
Hard Edits
Soft Edits
AssocHelp
H_CIGSDA2
Monday, August 25, 2014
Page 14 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.070_H
Variable Name
H_CIGSDA2
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
If the response is given in packs rather than as a number of cigarettes, multiply the
number of packs by 20, verify the result with the sample adult and enter the number of
cigarettes per day.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGSDA2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 66
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.080
Variable Name
CIGQTYR
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKNOW = 1,2
Universe-text
Sample adults 18+ who are every day or someday smokers
Question Text
? [F1]
During the PAST 12 MONTHS, have you stopped smoking for more than one day
BECAUSE YOU WERE TRYING TO QUIT SMOKING?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tried to quit
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
H_CIGQTYR
Monday, August 25, 2014
Page 16 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.080_H
Variable Name
H_CIGQTYR
Universe
Universe-text
Question Text
"Trying" means making an effort, not simply thinking about it or desiring it.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGQTYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.081_00.000
Variable Name
SMKANY
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and (SMKEV(e)
IN('2','9'))
Universe-text
Sample adults 18+ who have not smoked or don’t know if smoked 100+ cigarettes in
lifetime
Question Text
Have you ever smoked a cigarette EVEN ONE TIME?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Smoked even one cigarette
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SMKAGEX]
<2,R,D>[goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.082_00.000
Variable Name
SMKAGEX
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKANY(e)='1'
Universe-text
Sample adults 18+ who have not smoked or don’t know if smoked 100+ cigarettes in
lifetime but have smoked at least one cigarette
Question Text
How old were you the FIRST TIME you smoked a cigarette?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
Answer Codes
Allow 6-95,R,D
Question Type
Integer
Field Pane Description
Age first smoked
Fill Instructions
Special Instructions
Skip Instructions
<6-95> [goto SMKNOWX]
[goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.083_00.000
Variable Name
SMKNOWX
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and
('06'<=SMKAGEX(e)<='95')
Universe-text
Sample adults 18+ who have not smoked or don’t know if smoked 100+ cigarettes in
lifetime but have smoked at least one cigarette and gave an age in SMKAGEX question
Question Text
Do you NOW smoke cigarettes every day, some days or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One-answer list pane
Field Pane Description
Now smoke
Fill Instructions
Special Instructions
Skip Instructions
[goto VIGNO]
<1,2> [goto CIGDAMOX]
<3> [goto SMKNONOX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.084_01.000
Variable Name
SMKNONOX
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and SMKNOWX(e)='3'
Universe-text
Sample adults 18+ who have not smoked 100 cigarettes in lifetime but have smoked a
cigarette at least once in lifetime and are currently not smoking at all
Question Text
1 of 2
How long has it been since you smoked a cigarette?
* Enter number for time since smoked.
* Enter '95' for 95 or more.
Answer Codes
Allow 01-95,R,D
Question Type
Integer
Field Pane Description
How long since smoked-number
Fill Instructions
Special Instructions
Skip Instructions
<1-95> [goto SMKNOTPX]
[goto VIGNO
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.084_02.000
Variable Name
SMKNOTPX
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and
('01<=SMKNONOX(e)<='95')
Universe-text
Sample adults 18+ who have not smoked 100 cigarettes in lifetime but have smoked a
cigarette at least once in lifetime and are currently not smoking at all and answered 195 to the number part of this question
Question Text
2 of 2
* Enter time period for time since smoked a cigarette
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
Question Type
Pick one-answer list pane
Field Pane Description
How long since smoked-time period
Fill Instructions
Special Instructions
Skip Instructions
<1-4> [goto VIGNO]
<4> [if SMKNONOX gt (AGE - <15>), goto ERR1_SMKNOTPX
if (SMKAGEX + SMKNONOX gt AGE), goto ERR2_SMKNOTPX
Hard Edits
ERR2_SMKNOTPX
* Age started ([Fill1: SMKAGEX]) + years since last cigarette ([Fill2: SMKNONOX])
exceeds current age ([Fill3: AGE]).
Soft Edits
ERR1_SMKNOTPX
* Respondent LAST SMOKED before age 15?
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 22 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.085_00.000
Variable Name
CIGDAMOX
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and (SMKNOWX(e)
IN('1','2'))
Universe-text
Sample adults 18+ who have not smoked or don’t know if smoked 100+ cigarettes in
lifetime and are current every day or some day smokers
Question Text
On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
How many days smoked
Fill Instructions
Special Instructions
Skip Instructions
<0-30,R,D> [goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.090_1
Variable Name
VIGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
1 of 2
The next questions are about physical activities (exercise, sports, physically active
hobbies...) that you may do in your LEISURE time.
How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10
MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you
do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Vigorous activities for at least 10 minutes" as a header for this question, AHB.090_2,
AHB.100_1 and AHB.100_2.
Skip Instructions
<0,996,R,D>[goto MODNO]
<1-995>[goto VIGTP]
Hard Edits
Soft Edits
AssocHelp
H_VIGNO
Monday, August 25, 2014
Page 24 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.090_1_H
Variable Name
H_VIGNO
Universe
Universe-text
Question Text
Exercise, sports, or physically active hobbies are respondent defined.
Vigorous activities might include fast walking, fast bicycling, jogging,strenuous
swimming or sports play, vigorous aerobic dance, and strenuous gardening.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
VIGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.090_2
Variable Name
VIGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and VIGNO = 1-995
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
2 of 2
* Enter time period for vigorous leisure-time physical activities.
Answer Codes
1. Day
2. Week
3. Month
4. Year
Question Type
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Show answer name on the right. Do not allow "Refused" or "Don't know" answers.
Skip Instructions
<1-4> goto VIGLNGNO
[if (VIGNO gt <4> and VIGTP eq <1>) or
(VIGNO gt <28> and VIGTP eq <2>) or
(VIGNO gt <31> and VIGTP eq <3>) or
(VIGNO gt <365> and VIGTP eq <4>) goto ERR1_VIGTP]
Hard Edits
Soft Edits
ERR1_VIGTP
* [Fill1: VIGNO] times per [Fill2: VIGTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 26 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.100_1
Variable Name
VIGLNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) AND VIGTP = 1 - 4
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
? [F1]
1 of 2
About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.
Answer Codes
Question Type
Multi Part
Field Pane Description
How long - number
Fill Instructions
Special Instructions
Skip Instructions
<1-995>[goto VIGLNGTP]
[goto MODNO]
Hard Edits
Soft Edits
AssocHelp
H_VIGLNGNO
Monday, August 25, 2014
Page 27 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.100_1_H
Variable Name
H_VIGLNGNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
VIGLNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 28 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.100_2
Variable Name
VIGLNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and VIGLNGNO = 1- 995
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
2 of 2
* Enter time period for length of vigorous leisure-time physical activities.
Answer Codes
1. Minutes
2. Hours
Question Type
Multi Part
Field Pane Description
Fill Instructions
How long- time period
Fill1: [if VIGLNGTP = 1]
Fill2: [if VIGLNGTP = 2]
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.100_1
(VIGLNGNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers.
Skip Instructions
<1,2>goto MODNO
if VIGLNGNO lt <10> and VIGLNGTP eq <1> goto ERR1_VIGLNGTP;
if (VIGLNGNO gt <90> and VIGLNGTP eq <1>) or if VIGLNGNO gt <2> and
VIGLNGTP eq <2> goto ERR2_VIGLNGTP
Hard Edits
ERR1_VIGLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edits
ERR2_VIGLNGTP
* [Fill1: VIGLNGNO] [fill2: VIGLNGTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 29 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.110_1
Variable Name
MODNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT
LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE
increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year
do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Light or moderate activities for at least 10 minutes" as a header for this question,
AHB.110_2, AHB.120_1 and AHB.120_2.
Skip Instructions
<1-995>[goto MODTP]
<0, 996, R,D>[goto STRNGNO]
Hard Edits
Soft Edits
AssocHelp
H_MODNO
Monday, August 25, 2014
Page 30 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.110_1_H
Variable Name
H_MODNO
Universe
Universe-text
Question Text
This question is asking about physical activities (exercise, sports, physically active
hobbies) that the sample adult may do in his/her
LEISURE time.
Light or moderate activities include such activities as leisurely walking or bicycling, slow
swimming or dancing, and simple gardening.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MODNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.110_2
Variable Name
MODTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and MODNO = 1-995
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
2 of 2
* Enter time period for light or moderate leisure-time physical activities
Answer Codes
1. Day
2. Week
3. Month
4. Year
Question Type
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.110_1
(MODNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers.
Skip Instructions
<1-4> goto MODLNGNO
[if (MODNO gt <4> and MODTP eq <1>) or
(MODNO gt <28> and MODTP eq <2>) or
(MODNO gt <31> and MODTP eq <3>) or
(MODNO gt <365> and MODTP eq <4>)] goto ERR_MODNO
Hard Edits
Soft Edits
ERR_MODNO
* [Fill1: MODNO] times per [fill2: MODTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 32 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.120_1
Variable Name
MODLNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and MODTP = 1 - 4
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
? [F1]
1 of 2
About how long do you do these light or moderate leisure-time physical activities each
time?
* Enter number for length of light or moderate leisure-time physical activities.
Answer Codes
Question Type
Multi Part
Field Pane Description
How long - number
Fill Instructions
Special Instructions
Skip Instructions
<1-995>[goto MODLNGTP]
[goto STRNGNO]
Hard Edits
Soft Edits
AssocHelp
H_MODLNGNO
Monday, August 25, 2014
Page 33 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.120_1_H
Variable Name
H_MODLNGNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MODLNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.120_2
Variable Name
MODLNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and MODLNGNO = 1 995
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.
Answer Codes
1. Minutes
2. Hours
Question Type
Multi Part
Field Pane Description
How long - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.120_1
(MODLNGNO). Show answer name on the right. Do not allow "Refused" or "Don't
know" answers.
Skip Instructions
<1,2> goto STRNGNO
if MODLNGNO lt <10> and MODLNGTP eq <1> goto ERR1_MODLNGTP
if MODLNGNO gt <90> and MODLNGTP eq <1> or if MODLNGNO gt <2> and
MODLNGTP eq <2>goto ERR2_MODLNGTP
Hard Edits
ERR1_MODLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edits
ERR2_MODLNGTP
* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 35 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.130_1
Variable Name
STRNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
How often do you do LEISURE-TIME physical activities specifically designed to
STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all
such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you
do these activities?
* Enter number for strengthening acativities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity
Answer Codes
Question Type
Multi Part
Field Pane Description
Strengthening - number
Fill Instructions
Special Instructions "Strengthening activities" as a header for this question, and AHB.130_2.
Skip Instructions
<1-995>[goto STRNGTP]
<0, 996,R,D>[goto ALC1YR]
Hard Edits
Soft Edits
AssocHelp
H_STRNGNO
Monday, August 25, 2014
Page 36 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.130_1_H
Variable Name
H_STRNGNO
Universe
Universe-text
Question Text
This question is asking about physical activities (exercise, sports, physically active
hobbies) that the sample adult may do in his/her
LEISURE time.
Exercises to strengthen muscles are activities that require strenuous muscular
contractions such as weight lifting, resistance training, push-ups, sit-ups, etc.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
STRNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 66
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.130_2
Variable Name
STRNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and STRNGNO = 1-995
Universe-text
Sample adults 18+ who do strengthening activities
Question Text
2 of 2
* Enter time period for strengthening activities
Answer Codes
1. Day
2. Week
3. Month
4. Year
Question Type
Multi Part
Field Pane Description
Time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.130_1
(STRNGNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers
Skip Instructions
<1-4> [goto ALC1YR]
[If (STRNGNO gt <4> & STRNGTP = <1>) or (STRNGNO gt <28> & STRNGTP = <2>)
or
(STRNGNO gt <31> & STRNGTP = <3>) or (STRNGNO gt <365> & STRNGTP =
<4>) goto ERR_STRNGTP]
Hard Edits
Soft Edits
ERR_STRNGTP
* [Fill1: STRNGNO] times per [Fill2: STRNGTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 38 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.140
Variable Name
ALC1YR
Universe
HHSTAT4 = 'S'and AGE GE 18
Universe-text
Sample adults 18+
Question Text
? [F1]
These next questions are about drinking alcoholic beverages. Included are liquor such
as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Any ONE year 12 drinks
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ALC12MNO]
<2,R,D> [goto ALCLIFE]
Hard Edits
Soft Edits
AssocHelp
H_ALC1YR
Monday, August 25, 2014
Page 39 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.140_H
Variable Name
H_ALC1YR
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC1YR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.150
Variable Name
ALCLIFE
Universe
ASTATFLG=1 and AGE GE 18 and ALC1YR = 2, D, R
Universe-text
Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did
or refused to answer
Question Text
? [F1]
In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic
beverage?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Entire life 12 drinks
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ALC12MNO]
<2,R,D> [goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALCLIFE
Monday, August 25, 2014
Page 41 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.150_H
Variable Name
H_ALCLIFE
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALCLIFE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.160_1
Variable Name
ALC12MNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and (ALC1YR = 1 or
ALCLIFE = 1)
Universe-text
Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks
in their entire life
Question Text
? [F1]
1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcohoilic berveages were consumed in the past year.
*Enter '0' for Never.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Past year" as a header or this question, AHB.160_2, AHB.170, AHB.180_1 and
AHB.180_2.
Skip Instructions
<1-365>[goto ALC12MTP]
<0,D,R>[goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALC12MNO
Monday, August 25, 2014
Page 43 of 66
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.160_1_H
Variable Name
H_ALC12MNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC12M
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.160_2
Variable Name
ALC12MTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and ALC12MNO = 1 365
Universe-text
Sample adults 18+ who drank at least once in the past year
Question Text
2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.
Answer Codes
1. Week
2. Month
3. Year
Question Type
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.160_1
(ALC12MNO). Show answer name on the right.
Skip Instructions
<1-3> [goto ALCAMT]
[If (ALC12MNO gt <7> & ALC12MTP = <1>) or (ALC12MNO gt <31> & ALC12MTP =
<2>) or
(ALC12MNO gt <365> & ALC12MTP = <3>) goto ERR_ALC12MTP]
Hard Edits
ERR_ALC12MTP
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time
period.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 45 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.170
Variable Name
ALCAMT
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and ALC12MTP = 1-3
Universe-text
Sample adults 18+ who have had at least 1 drink in the past year
Question Text
? [F1]
In the PAST YEAR, on those days that you drank alcoholic
beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.
Answer Codes
Question Type
Integer
Field Pane Description
Average # of drinks/day
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D,R>[goto ALC5UPNO]
<10-95>[goto ERR_ALCAMT]
Hard Edits
Soft Edits
ERR_ALCAMT
* [Fill: ALCAMT] drinks is an unusually high number.
* Please verify.
* Do not probe
AssocHelp
H_ALCAMT
Monday, August 25, 2014
Page 46 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.170_H
Variable Name
H_ALCAMT
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALCAMT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 47 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_1
Variable Name
ALC5UPNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and ALC12MNO = 1-365
Universe-text
Sample adults 18+ who have had at least 1 drink in the past year
Question Text
? [F1]
1 of 2
In the PAST YEAR, on how many DAYS did you have [fill: 5 or more/4 or more] drinks
of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have [fill: 5 or more/4 or more]
drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.
Answer Codes
Question Type
Multi Part
Field Pane Description
Fill Instructions
Number
If SEX=1 fill “5 or more”; else if SEX=2 fill “4 or more”
Special Instructions "Days with 5 or more drinks " as a header for this question and AHB.180_2.
Skip Instructions
<1-365>[goto ALC5UPTP]
<0,R,D>[goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALC5UP
Monday, August 25, 2014
Page 48 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_1_H
Variable Name
H_ALC5UP
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC5UP
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 49 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_2
Variable Name
ALC5UPTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and ALC5UPNO = 1365.
Universe-text
Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least
once in the past year
Question Text
2 of 2
* Enter time period for days per week, per month or per year.
Answer Codes
1. Week
2. Month
3. Year
Question Type
Multi Part
Field Pane Description
Fill Instructions
Time period
(For Hard Edit): If SEX=1 fill “5 or more”; else if SEX=2 fill “4 or more”
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.180_1
(ALC5UPNO). Show answer name on the right.
Skip Instructions
<1-3> [goto BINGE1]
[If (ALC5UPNO gt <7> & ALC5UPTP = <1>) or
(ALC5UPNO gt <31> & ALC5UPTP = <2>) or
(ALC5UPNO gt <365> & ALC5UPTP = <3>) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP)
lt number of days per year with 5 or more (for males)/4+ (females) drinks (calculated
from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]
Hard Edits
ERR1_ALC5UPTP
* [Fill1: ALC5UPNO] days per [Fill2: ALC5UPTP] exceeds number possible in this time
period.
* Please correct
ERR2_ALC5UPTP
* Number of days had [fill: 5 or more/4 or more] drinks exceeds number of days drank.
* Please correct.
* Do not probe.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.181
Variable Name
BINGE1
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and ALC5UPNO = 1-365
Universe-text
Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least
once in the past year
Question Text
? [F1]
Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many
times did you have [fill: 5 or more/4 or more] drinks on an occasion?
* Enter '0' if none.
* Enter '60' if 60 or more times.
Answer Codes
(Allow 0-60,R,D)
Question Type
Integer
Field Pane Description
Fill Instructions
Number
If SEX=1 fill “5 or more”; else if SEX=2 fill “4 or more”
Special Instructions "Days with 5 or more drinks " as a header for this question and AHB.180_2.
Skip Instructions
<0-60,R,D> [goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_BINGE
Monday, August 25, 2014
Page 51 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.181_H
Variable Name
H_BINGE
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
BINGE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
H_BINGE
Monday, August 25, 2014
Page 52 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_01
Variable Name
AHGT_FT
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How tall are you without shoes?
* Enter "M" to record metric measurements
Answer Codes
Question Type
Integer
Field Pane Description
Current height
Fill Instructions
Special Instructions "Current height" to the left. "feet" to the right.
Don't allow a '.' (a period) after a number. This is a 2 character field and will be picked
up in output
Skip Instructions
<2-7> [goto AHGT_IN]
[goto AWGT_LB]
[goto AHGT_M]
[if AHGT_FT NE<2-7,R,D,M> goto ERR1_AHGT_FT]
[if AHGT_FT = <2,3> goto ERR2_AHGT_FT]
Hard Edits
ERR1_AHGT_FT
* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.
Soft Edits
ERR2_AHGT_FT
* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 53 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_02
Variable Name
AHGT_IN
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and AHGT_FT = 2-7
Universe-text
Sample adults 18+ who answered their height in feet
Question Text
How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.
Answer Codes
Question Type
Integer
Field Pane Description
Inches
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.190_01
(AHGT_FT). Show "inches" on the right.
If AHGT_FT = M, Refused, or Don’t know, do not calculate a value for AHTINCH
Create variable AHTINCH as follows: (AHGT_FT * 12) + AHGT_IN = AHTINCH
If AHGT_IN = Refused or Don’t know use ‘0’ for AHGT_IN when calculating AHTINCH
If ERR2_AHGT_IN is displayed, set AHGT_FLG = ‘1’
If ERR2_AHGT_IN is closed or you goto another screen from it, leave AHGT_FLG = ‘1’
If ERR2_AHGT_IN is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
goto ERR_AHGT_IN
<0-11,R,D> if (SEX = ‘1’ and (AHTINCH lt ‘61’ or AHTINCH gt ‘75’)) or
(SEX = ‘2’ and (AHTINCH lt ‘56’ or AHTINCH gt ‘69’))
goto ERR2_AHGT_IN
else
goto AWGT_LB
Hard Edits
ERR1_AHGT_IN
* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.
Soft Edits
ERR2_AHGT_IN
* Please verify that the height was entered correctly. Probe only if necessary.
AssocHelp
Monday, August 25, 2014
Page 54 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_03
Variable Name
AHGT_M
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and AHGT_FT = M
Universe-text
Sample adults 18+ who choose to give their height in metric measurements
Question Text
How tall are you without shoes?
* Enter height in metric.
Answer Codes
Question Type
Integer
Field Pane Description
Current height
Fill Instructions
Special Instructions "meters" to the right.
Skip Instructions
goto ERR_AHGT_M
<0-2> goto AHGT_CM
goto AWGT_LB
Hard Edits
ERR_AHGT_M
* If height is being given in centimeters only, enter "0"; otherwise enter number of
meters.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 55 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_04
Variable Name
AHGT_CM
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and AHGT_M = 0-2
Universe-text
Sample adults 18+ who answered their height in meters
Question Text
*Enter centimeters.
Answer Codes
Question Type
Integer
Field Pane Description
Centimeters
Fill Instructions
Special Instructions "centimeters" to the right.
If AHGT_M = Refused or Don’t know, do not calculate a value for AHTCM
Create variable AHTCM as follows: (AHGT_M * 100) + AHGT_CM = AHTCM
If AHGT_CM = Refused or Don’t know use ‘0’ for AHGT_CM when checking if height
exceeds maximum allowed, when checking if height is very small, or when calculating
AHTCM
If ERR3_AHGT_CM is displayed, set AHGT_FLG = ‘1’
If ERR3_AHGT_CM is closed or you goto another screen from it, leave AHGT_FLG =
‘1’
If ERR3_AHGT_CM is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
goto ERR2_AHGT_CM
<0-241,R,D> if (AHGT_M eq ‘2’ and AHGT_CM gt ‘41’) or (AHGT_M eq ‘1’ and
AHGT_CM gt ‘141’)
goto ERR1_AHGT_CM
elseif (SEX = ‘1’ and (AHTCM lt ‘156’ or AHTCM gt ‘192’)) or
(SEX = ‘2’ and (AHTCM lt ‘143’ or AHTCM gt ‘176’))
goto ERR3_AHGT_CM
else
goto AWGT_LB
Hard Edits
ERR1_AHGT_CM
* Total height exceeds maximum allowed.
* Please correct.
ERR2_AHGT_CM
* If [fill: AHGT_M] meters exactly, enter "0"; otherwise enter number of centimeters.
Soft Edits
ERR3_AHGT_CM
* Please verify that the height was entered correctly. Probe only if necessary.
AssocHelp
Monday, August 25, 2014
Page 56 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_05
Variable Name
AHTINCH
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If AHGT_FT = M, Refused or Don’t know, do not calculate a value for AHTINCH
Create variable AHTINCH as follows: (AHGT_FT * 12) + AHGT_IN = AHTINCH
If AHGT_IN = Refused or Don’t know, use ‘0’ for AHGT_IN when calculating AHTINCH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_06
Variable Name
AHTCM
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If AHGT_M = Refused or Don’t know, do not calculate a value for AHTCM
Create variable AHTCM as follows: (AHGT_M * 100) + AHGT_CM = AHTCM
If AHGT_CM = Refused or Don’t know use ‘0’ for AHGT_CM when calculating AHTCM
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_07
Variable Name
AHGT_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR2_AHGT_IN or ERR3_AHGT_CM is displayed, set AHGT_FLG = ‘1’
If ERR2_AHGT_IN or ERR3_AHGT_CM is closed or you goto another screen from it,
leave AHGT_FLG = ‘1’
If ERR2_AHGT_IN or ERR3_AHGT_CM is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 59 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_08
Variable Name
AMETERS
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable AMETERS as follows:
if AHTINCH ne ‘empty’
set AMETERS = AHTINCH/39.37008
elseif AHTCM ne ‘empty’
set AMETERS = AHTCM/100
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_01
Variable Name
AWGT_LB
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more
Answer Codes
Question Type
Integer
Field Pane Description
Current weight
Fill Instructions
Special Instructions "pounds" on the right.
If ERR2_AWGT_LB is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_LB is closed or you goto another screen from it, leave AWGT_FLG =
‘1’
If ERR2_AWGT_LB is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
<50-500> if AWGT_LB lt ‘50’ or AWGT_LB gt ‘500’
goto ERR1_AWGT_LB
elseif ((SEX = ‘1’ and (AWGT_LB lt ’113’ or AWGT_LB gt ‘316’)) or
((SEX = ‘2’ and (AWGT_LB lt ’96’ or AWGT_LB gt ‘293’))
goto ERR2_AWGT_LB
elseif AHGT_FLG = ‘1’ and AWGT_FLG = ‘1’
[goto next section]
else
calculate the BMI (Body Mass Index) - See BMI spec page
[goto next section]
Hard Edits
ERR1_AWGT_LB
* Weight is out of range (50-500).
* Please correct.
Soft Edits
ERR2_AWGT_LB
* Please verify that the weight was entered correctly. Probe only if necessary.
AssocHelp
Monday, August 25, 2014
Page 61 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_02
Variable Name
AWGT_KG
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')) and AWGT_LB = M
Universe-text
Sample adults 18+ who choose to give their weight in metric measurements
Question Text
How much do you weigh without shoes?
* Enter weight in kilograms
Answer Codes
<23-226>
Refused
Don't know
Question Type
Integer
Field Pane Description
Current weight
Fill Instructions
Special Instructions "kilograms" to the right.
If ERR2_AWGT_KG is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_KG is closed or you goto another screen from it, leave AWGT_FLG =
‘1’
If ERR2_AWGT_KG is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
<23-226> if AWGT_KG lt ‘23’ or AWGT_KG gt ‘226’
goto ERR1_AWGT_KG
elseif ((SEX = ‘1’ and (AWGT_KG lt ’51’ or AWGT_KG gt ‘143’)) or
((SEX = ‘2’ and (AWGT_KG lt ’43’ or AWGT_KG gt ‘133’))
goto ERR2_AWGT_KG
elseif AHGT_FLG = ‘1’ and AWGT_FLG = ‘1’
goto next section
else
calculate the BMI (Body Mass Index) - See BMI spec page
goto next section
Hard Edits
ERR1_AWGT_KG
*Weight is out of range (23-226).
* Please correct.
Soft Edits
ERR2_AWGT_KG
* Please verify that the weight was entered correctly. Probe only if necessary.
AssocHelp
Monday, August 25, 2014
Page 62 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_03
Variable Name
AWGT_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR2_AWGT_LB or ERR2_AWGT_KG is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_LB or ERR2_AWGT_KG is closed or you goto another screen from it,
leave AWGT_FLG = ‘1’
If ERR2_AWGT_LB or ERR2_AWGT_KG is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_04
Variable Name
AKG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable AKG as follows:
If AWGT_LB ne ‘M’, ‘Refused’, ‘Don’t know’, or ‘empty’
set AKG = AWGT_LB/2.20462
elseif AWGT_KG ne ‘Refused’, ‘Don’t know’, or ‘empty’
set AKG = AWGT_KG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_05
Variable Name
ABMI
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable ABMI as follows: (AKG/(AMETERS * AMETERS)) = ABMI
If ERR_ABMI is displayed, set ABMI_FLG = ‘1’
f ERR_ABMI is closed or you goto another screen from it, leave ABMI_FLG = ‘1’
If ERR_ABMI is suppressed, reset ABMI_FLG = ‘2’
Skip Instructions
if (SEX = ‘1’ and (ABMI lt ‘18’ or ABMI gt ‘44’)) or
(SEX = ‘2’ and (ABMI lt ‘17’ or ABMI gt ‘49’))
goto ERR_ABMI
else
[goto next section]
Hard Edits
Soft Edits
ERR_ABMI
* Please verify that the entries for height and weight were entered correctly. Probe only
if necessary.
AssocHelp
Monday, August 25, 2014
Page 65 of 66
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_06
Variable Name
ABMI_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR_ABMI is displayed, set ABMI_FLG = ‘1’
If ERR_ABMI is closed or you goto another screen from it, leave ABMI_FLG = ‘1’
If ERR_ABMI is suppressed, reset ABMI_FLG = ‘2’
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 66 of 66
2015 Q1 NHIS Instrument Spec Report
Section name: Health Care Access and Utilization
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.020
Variable Name
AUSUALPL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
The next questions are about health care.
Is there a place that you USUALLY go to when you are sick or need advice about your
health?
Answer Codes
1. Yes
2. There is NO place
3. There is MORE THAN ONE place
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Usually go when sick
Fill Instructions
Special Instructions Answer on the right.
Skip Instructions
<1,3> [go to APLKIND]
<2,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
AssocHelp
H_AUSUALPL
Monday, August 25, 2014
Page 1 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.020_H
Variable Name
H_AUSUALPL
Universe
Universe-text
Question Text
A place to USUALLY go when sick or in need of advice about one's health includes:
Walk-in clinic
Doctor's office
Clinic
Health Center
Health Maintenance Organization
Hospital - Emergency room or outpatient clinic
Military or VA health care facility
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AUSUALPL
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.030
Variable Name
APLKIND
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AUSUALPL(e)
IN('1','3')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
Question Text
? [F1]
[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other
place?
[Fill2: What kind of place do you go to most often - a clinic, doctor's office, emergency
room, or some other place?]
Answer Codes
1. Clinic or health center
2. Doctor's office or HMO
3. Hospital emergency room
4. Hospital outpatient department
5. Some other place
6. Doesn’t go to one place most often
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Go to most often
Fill 1 = [If AUSUALPL (AAU.020) = 1]
Fill2 = [If AUSUALPL (AAU.020) = 3 ]
Special Instructions
Skip Instructions
<1-5> [go to AHCPLROU]
<6,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
AssocHelp
H_APLKIND
Monday, August 25, 2014
Page 3 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.030_H
Variable Name
H_APLKIND
Universe
Universe-text
Question Text
"Doctor" includes medical doctors, as well as other health care professionals, such as
general practitioners, psychologists, nurses, chiropractors, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
APLKIND
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
H_APLKIND
Monday, August 25, 2014
Page 4 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.035
Variable Name
AHCPLROU
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('1'
<=APLKIND(e) <='5')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who
reported place goes most often as a clinic or health center, doctor's office or HMO,
hospital emergency room, hospital outpatient department, or some other place
Question Text
? [F1]
Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need
routine or preventive care, such as a physical examination or check up?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Routine/prev. care place
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHCCHGYR]
<2,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
AssocHelp
H_AHCPLROU
Monday, August 25, 2014
Page 5 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.035_H
Variable Name
H_AHCPLROU
Universe
Universe-text
Question Text
Routine or preventive care is a health procedure or series of health procedures done to
help a person avoid illness or to detect problems
early.
A general physical exam or check-up is an examination not for a specific condition or
problem. This may include the following: a periodic health examination, a complete
medical examination, an annual health check-up or a comprehensive physical
examination. It does NOT include dental exams and vision tests.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AHCPLROU
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.037
Variable Name
AHCPLKND
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AUSUALPL(e)
IN('2','7','9') or APLKIND(e) IN('6','7','9') or AHCPLROU(e) IN('2','7','9'))
Universe-text
Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a
usual source of sick care; who have a usual source of sick care but do not go to one
place most often or Ref/DK what kind of place; who have a usual source of sick care,
but it is not same place as usual source of routine/preventive care; who have a usual
source of sick care but Ref/DK if it is same place as usual source of routine/preventive
care.
Question Text
What kind of place do you USUALLY go to when you need routine or preventive care,
such as a physical examination or check-up?
Answer Codes
0. Doesn't get preventive care anywhere
1. Clinic or health center
2. Doctor's office or HMO
3. Hospital emergency room
4. Hospital outpatient department
5. Some other place
6. Doesn't go to one place most often
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Usually go for routine/prev. care
Fill Instructions
Special Instructions
Skip Instructions
<0-6,R,D>
if AUSUALPL=2,R,D [goto APRVTRYR]
ELSE goto AHCCHGYR
Hard Edits
Soft Edits
AssocHelp
H_AHCPLROU
Monday, August 25, 2014
Page 7 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.040
Variable Name
AHCCHGYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AUSUALPL(e)
IN('1','3') OR AHCPLROU(e)='1')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who
reported same place as usual source of routine/preventive care]
Question Text
? [F1]
At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you
USUALLY go for health care?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Changed health care place
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto AHCCHGHI]
<2,R,D>[goto APRVTRYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCCHGYR
Monday, August 25, 2014
Page 8 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.040_H
Variable Name
H_AHCCHGYR
Universe
Universe-text
Question Text
"Change the place" refers to a change in health care providers, not a change of
address for a current provider.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCCHGYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.050
Variable Name
AHCCHGHI
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCCHGYR(e) =
'1'
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who
CHANGED their USUAL place for health care in past 12 months
Question Text
Was this change for a reason related to health insurance?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Change due to health ins.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APRVTRYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.051_00.010
Variable Name
APRVTRYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, did you have any trouble finding a general doctor or
provider who would see you?
Answer Codes
1 Yes
2 No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Trouble finding doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,>[goto APRVTRFD ]
<2,R,D>[goto ADRNANP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.053_00.010
Variable Name
APRVTRFD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and APRVTRYR(e)='1'
Universe-text
Sample adults 18+ who had trouble finding a provider
Question Text
Were you able to find a general doctor or provider who could see you?
Answer Codes
1 Yes
2 No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Able to find a doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ADRNANP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.057_00.010
Variable Name
ADRNANP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were you told by a doctor’s office or clinic that they
would not accept you as a new patient?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Not accept as patient
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ADRNAI]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.059_00.010
Variable Name
ADRNAI
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were you told by a doctor’s office or clinic that they
did not accept your health care coverage?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Not accept coverage
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_1
Variable Name
AHCDLY_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
There are many reasons people delay getting medical care.
Have you delayed getting care for any of the following reasons in the PAST 12
MONTHS?
...You couldn't get through on the telephone.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Couldn't get through on phone
Fill Instructions
Special Instructions "Past 12 months" as a header for this question as well as AAU061_2 - AAU.061_5.
Skip Instructions
<1,2,R,D>[goto AHCDLY_2]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Monday, August 25, 2014
Page 15 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_1_H
Variable Name
H_AHCDLY_1
Universe
Universe-text
Question Text
"Delayed" assumes that medical care has been or will eventually be received.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCDLY_1, AHCDLY_2, AHCDLY_4 and AHCDLY_5
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_2
Variable Name
AHCDLY_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get an appointment soon enough.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
No appt. soon enough
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_3]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Monday, August 25, 2014
Page 17 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_3
Variable Name
AHCDLY_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...Once you get there, you have to wait too long to see the doctor.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Wait too long to see Dr.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_4]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_3
Monday, August 25, 2014
Page 18 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_3_H
Variable Name
H_AHCDLY_3
Universe
Universe-text
Question Text
"Delayed" assumes that medical care has been or will eventually be received.
Waiting time to see the doctor includes only time from arrival until the health care
provider is seen.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCDLY_3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_4
Variable Name
AHCDLY_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...The (clinic/doctor's) office wasn't open when you could get there.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Clinic/office not open
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_5]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Monday, August 25, 2014
Page 20 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_5
Variable Name
AHCDLY_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...You didn't have transportation.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
No transportation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_1]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Monday, August 25, 2014
Page 21 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_1
Variable Name
AHCAFY_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Prescription medicines.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Prescription medicines
Fill Instructions
Special Instructions "Past 12 mo. (needed but can't aford)" as a header for this question as well as
AAU.111_2 - AAU.111_4.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1,2,R,D>[goto AHCAFY_2]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_1
Monday, August 25, 2014
Page 22 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_1_H
Variable Name
H_AHCAFY_1
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Prescription Medicines are medication which can only be obtained with the approval of
a licensed health care professional. The medication is usually obtained through a
pharmacy using a written note or telephoned instructions from the health care
professional to the pharmacy.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_1
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_2
Variable Name
AHCAFY_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Mental health care or counseling.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Mental health care/counselling
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_3]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_2
Monday, August 25, 2014
Page 24 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_2_H
Variable Name
H_AHCAFY_2
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Mental Health Care is respondent defined.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_3
Variable Name
AHCAFY_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Dental care (including check ups).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Dental care
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_4]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_3
Monday, August 25, 2014
Page 26 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_3_H
Variable Name
H_AHCAFY_3
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_3, AHCAFY_4
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_4
Variable Name
AHCAFY_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Eyeglasses.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Eyeglasses
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_5]]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_3
Monday, August 25, 2014
Page 28 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.111_5.010
Variable Name
AHCAFY_5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...To see a specialist.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_6]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.111_6.010
Variable Name
AHCAFY_6
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Follow-up care.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AWORPAY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.113_00.010
Variable Name
AWORPAY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
If you get sick or have an accident, how worried are you that you will be able to pay
your medical bills? Are you very worried, somewhat worried, or not at all worried?
Answer Codes
1. Very worried
2. Somewhat worried
3. Not at all worried
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D>[goto AHICOMP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.113_00.020
Variable Name
AHICOMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In regard to your health insurance or health care coverage, how does it compare to a
year ago? Is it better, worse, or about the same?
Answer Codes
1. Better
2. Worse
3. About the same
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,3,R,D>[goto ARX12MO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.126_01.010
Variable Name
ARX12MO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were you prescribed medication by a doctor or
other health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Past 12 months prescriptions
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ARX12_1]
<2,R,D> [goto ARX12_5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_01.010
Variable Name
ARX12_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You skipped medication doses to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Past 12 months skipped medication
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_02.010
Variable Name
ARX12_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You took less medicine to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Took less medicine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 35 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_03.010
Variable Name
ARX12_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You delayed filling a prescription to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Delayed filling prescription
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_04.010
Variable Name
ARX12_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You asked your doctor for a lower cost medication to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Lower cost medication
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_05.010
Variable Name
ARX12_5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You bought prescription drugs from another country to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Drugs from another country
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_6]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_06.010
Variable Name
ARX12_6
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You used alternative therapies to save money.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Used alternative therapies
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ADENLONG]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.135
Variable Name
ADENLONG
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A8
About how long has it been since you last saw a dentist? Include all types of dentists,
such as orthodontists, oral surgeons, and all other dental specialists, as well as dental
hygienists.
Answer Codes
0. Never
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Last saw dentist
Fill Instructions
Special Instructions Answer on the right.
Skip Instructions
<0-5,R,D>[ goto AHCSY1_1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_1
Variable Name
AHCSY1_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse,
or clinical social worker.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Mental heallth professional
Fill Instructions
Special Instructions "Past 12 mo. (seen/talked to)" as a header for this question as well as AAU.141_2 AAU.230.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1,2,R,D>[ goto AHCSY1_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 41 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_2
Variable Name
AHCSY1_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone
who prescribes eyeglasses).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Eye doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_3
Variable Name
AHCSY1_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A foot doctor.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Foot doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_4
Variable Name
AHCSY1_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A chiropractor.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chiropractor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_5
Variable Name
AHCSY1_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or
occupational therapist.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Physical/speech/resp. therapist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_6]
Hard Edits
Soft Edits
AssocHelp
H_AHCSY1_5
Monday, August 25, 2014
Page 45 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_5_H
Variable Name
H_AHCSY1_5
Universe
Universe-text
Question Text
A "physical therapist" is a health care professional skilled in working with persons with
health problems resulting from injury, disease, or developmental problems. A physical
therapist diagnoses muscle and joint problems and provides exercises and treatments.
A "speech therapist" is a health care professional skilled in working with communication
and language disorders. Speech pathologists diagnose speech and language
problems and provide therapy including treatment for stuttering, impaired articulation, or
language or voice impairment.
A "respiratory therapist" is a health care professional skilled in working with persons
with respiratory difficulties. Respiratory therapists treat and manage the care of
persons with respiratory diseases. This may include administration of breathing
treatments, oxygen, and education of patients in regards to respiratory treatment
procedures.
An "audiologist" is a health care professional skilled in working with hearing problems.
An audiologist diagnoses hearing problems and their nature, and determines if a
person can benefit from using hearing aids.
An "occupational therapist" is a health care professional skilled in working with health
problems resulting from injury, disease, or developmental problems. Occupational
therapy involves working on functional activities such as dressing, feeding, and writing.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSY1_5
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 46 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_6
Variable Name
AHCSY1_6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
{Fill1: ...A nurse practitioner, physician assistant, or midwife.
Or Filll2: ...A nurse practitioner or physician assistant.}
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Nurse prac./phys. asst./midwife
fill1: If SEX=2 Fill1: ...A nurse practitioner, physician assistant, or midwife”
Else if SEX=1 Fill2: ...A nurse practitioner or physician assistant.
Special Instructions
Skip Instructions
<1,2,R,D>[if SEX=1goto AHCSY8_8;
else if SEX=2 goto AHCSYR7]
Hard Edits
Soft Edits
AssocHelp
H_AHCSY1_6
Monday, August 25, 2014
Page 47 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_6_H
Variable Name
H_AHCSY1_6
Universe
Universe-text
Question Text
A nurse practitioner is a registered nurse who has completed an advanced program of
study leading to an expanded role in health care. Nurse practitioners are able to take
health histories, perform physical examinations, order tests, and prescribe treatments
including medications. Nurse practitioners work under the supervision of a doctor, but
not necessarily in the presence of the doctor.
A nurse midwife is a registered nurse who has completed an advanced program of
study leading to an expanded role in health care for women. Nurse midwives provide
gynecological, pregnancy and delivery care to women. Nurse midwives work under the
supervision of a doctor, but not necessarily in the presence of the doctor.
A physician assistant works under the supervision of a physician to provide diagnostic,
preventative, and therapeutic health care services. Duties may include examining
patients, interpreting and ordering x-rays and lab tests, and the diagnosis and treatment
of minor injuries.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSY1_6
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 48 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.200
Variable Name
AHCSYR7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX = '2'
Universe-text
Sample adults 18+ who are female
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A doctor who specializes in women's health (an obstetrician/gynecologist).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
OB/GYN
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AHCSY8_ 8]
Hard Edits
Soft Edits
AssocHelp
H_AHCSYR7
Monday, August 25, 2014
Page 49 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.200_H
Variable Name
H_AHCSYR7
Universe
Universe-text
Question Text
An Obstetrician/Gynecologist is a medical doctor who treats women, pregnancy, and
diseases of he female reproductive system, including the breasts.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSYR7
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.211_1
Variable Name
AHCSY8_8
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A medical doctor who specializes in a particular medical disease or problem (other
than obstetrician/gynecologist, psychiatrist, or ophthalmologist (AHF-thal-MOL-oh-jist)).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Specialist doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AHCSY8_ 9]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.211_2
Variable Name
AHCSY8_ 9
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A general doctor who treats a variety of illnesses (a doctor in general practice, family
medicine, or internal medicine)?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
General doctor
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHCSYR10]
<2,R,D> [goto AHERNOYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.230
Variable Name
AHCSYR10
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCSY8_9(e)='1'
Universe-text
Sample adults 18+ who have seen or talked to a general doctor during the past 12
months
Question Text
Does that doctor treat children and adults (a doctor in general practice or family
medicine)?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Doctor treats children and adults
Fill Instructions
Special Instructions Indent to indicate that this is a follow on from the previous question.
Skip Instructions
<1,2,R,D> [go to AHERNOYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 53 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.240
Variable Name
AHERNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A9 ? [F1]
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL
EMERGENCY ROOM about your own health (This includes emergency room visits that
resulted in a hospital admission.)?
Answer Codes
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Number of times in ER
Fill Instructions
Special Instructions "Past 12 months as a header for this question as well as AAU.250 - AAU.280.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<0,R,D> [go to AHCHYR]
<1-8> [goto AERVISND]
Hard Edits
Soft Edits
AssocHelp
H_AHERNOYR
Monday, August 25, 2014
Page 54 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.240_H
Variable Name
H_AHERNOYR
Universe
Universe-text
Question Text
Hospital Emergency Room is an emergency care facility at a hospital.
Do NOT include emergency care received at a clinic or HMO. Include emergency room
visits which resulted in admission for inpatient care.
Do not include visits to outpatient clinics, urgent care facilities and the like.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHERNOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 55 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.243_00.010
Variable Name
AERVISND
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOYR<='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
Thinking about your most recent emergency room visit, did you go to the emergency
room either at night or on the weekend?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AERHOS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.245_00.010
Variable Name
AERHOS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOYR<='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
Did this emergency room visit result in a hospital admission?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AERREAS1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_01.010
Variable Name
AERREAS1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
Tell me which of these apply to your last emergency room visit?
… You didn't have another place to go
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_02.020
Variable Name
AERREAS2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
… Your doctor’s office or clinic was not open
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 59 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_03.030
Variable Name
AERREAS3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
… Your health provider advised you to go
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_04.040
Variable Name
AERREAS4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
… The problem was too serious for the doctor’s office or clinic
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 61 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_05.050
Variable Name
AERREAS5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
… Only a hospital could help you
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS6]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_06.060
Variable Name
AERREAS6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
… the emergency room is your closest provider
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS7]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_07.070
Variable Name
AERREAS7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
…you get most of your care at the emergency room
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AERREAS8]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.248_08.080
Variable Name
AERREAS8
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01'
<=AHERNOY2 (e) <='08')
Universe-text
Sample adults 18+ who had at least one ER visit in the past year
Question Text
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
…you arrived by ambulance or other emergency vehicle
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHCHYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 65 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.250
Variable Name
AHCHYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or
other health care professional?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Home care - nurse/hlth. prof.
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto AHCHMOYR]
<2,R,D>[goto AHCNOYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCHYR
Monday, August 25, 2014
Page 66 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.250_H
Variable Name
H_AHCHYR
Universe
Universe-text
Question Text
At HOME refers to the sample adult's own home and everyone else's home in which
the sample adult was staying at the time. This could be a house, apartment, motor
home, houseboat, trailer, or other dwelling. Do not include visits by a doctor while the
sample person was in a hospital or institutionalized.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCHYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 67 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.260
Variable Name
AHCHMOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCHYR(e) = '1'
Universe-text
Sample adults 18+ who received home care from a health professional during the past
12 months
Question Text
? [F1]
During how many of the PAST 12 MONTHS did you receive care AT HOME from a
health care professional?
Answer Codes
Question Type
Integer
Field Pane Description
Number of months
Fill Instructions
Special Instructions Indent to indicate that this is a follow up from the previous question.
Skip Instructions
<1-12,R,D>[goto AHCHNOYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCHMOYR
Monday, August 25, 2014
Page 68 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.260_H
Variable Name
H_AHCHMOYR
Universe
Universe-text
Question Text
At HOME refers to the sample adult's own home and everyone else's home in which
the sample adult was staying at the time. This could be a house, apartment, motor
home, houseboat, trailer, or other dwelling. Do not include visits by a doctor while the
sample person was in a hospital or institutionalized.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCHMOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 69 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.270
Variable Name
AHCHNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCHYR(e) = '1'
Universe-text
Sample adults 18+ who received home care from a health professional during the past
12 months
Question Text
(book) A10
What was the total number of home visits received during {Fill1: that month/Fill2: those
months}?
Answer Codes
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Number of visits
Fill1: if [AHCHMOYR = 1]
Fill2: if [AHCHMOYR NE 1]
Special Instructions Indent to indicate that this is a follow up from AAU.270.
Skip Instructions
<1-8,R,D>[goto AHCNOYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 70 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.280
Variable Name
AHCNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A9 ? [F1]
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or
other health care professional about your own health at a DOCTOR’S OFFICE, A
CLINIC, OR SOME OTHER PLACE? Do not include times you were hospitalized
overnight, visits to hospital emergency rooms, home visits, dental visits, or telephone
calls.
Answer Codes
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Number of office visits
Fill Instructions
Special Instructions
Skip Instructions
<0-8,R,D>[goto ASRGYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCNOYR
Monday, August 25, 2014
Page 71 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.280_H
Variable Name
H_AHCNOYR
Universe
Universe-text
Question Text
"Doctor" includes medical doctors as well as other health care professionals, such as
general practitioners, psychologist, nurses, chiropractors, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCNOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 72 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.290
Variable Name
ASRGYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical
procedures either as an inpatient or outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as
setting bones or removing growths.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Surgery/surgical procedures
Fill Instructions
Special Instructions "Past 12 months as a header for this question as well as AAU.300 and AAU.305.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1>[goto ASRGNOYR]
<2,R,D> [goto AMDLONG].
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 73 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.300
Variable Name
ASRGNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ASRGYR(e) = '1'
Universe-text
Sample adults 18+ who had surgery or surgical procedures during past 12 months
Question Text
Including any times you may have already told me about, HOW MANY DIFFERENT
TIMES have you had surgery during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.
Answer Codes
Question Type
Integer
Field Pane Description
Number of surgeries
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1-95,R,D> [goto AMDLONG].
<11-95>[goto ERR_ASGYR]
Hard Edits
Soft Edits
* {ASRGYR} is an unusually large number.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 74 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.305
Variable Name
AMDLONG
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A8 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care
professional about your own health? Include doctors seen while a patient in a hospital.
Answer Codes
0. Never
1. 6 months or less
2. More than 6 months but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Last saw/talked with doctor/hlth. prof.
Fill Instructions
Special Instructions Answer name on the right.
Skip Instructions
<0-5,R,D> [goto HIT1A]
Hard Edits
Soft Edits
AssocHelp
H_AMDLONG
Monday, August 25, 2014
Page 75 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.305_H
Variable Name
H_AMDLONG
Universe
Universe-text
Question Text
"Medical doctor" refers to both medical doctors (M.D.s) and osteopathic physicians
(D.O.s), including general practitioners and all types of specialists; and their assistants.
Do not include person who do not have an M.D. or D.O. degree, such as dentists, oral
surgeons, chiropractors, chiropodists, podiatrists, naturopaths, Christian Science
healers, opticians, optometrists, psychologists, etc., unless they assist an M.D. or D.O.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AMDLONG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 76 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.010
Variable Name
HIT1A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Look up health information on the Internet.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT2A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 77 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.020
Variable Name
HIT2A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Fill a prescription.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT3A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 78 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.030
Variable Name
HIT3A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Schedule an appointment with a health care provider.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT4A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 79 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.040
Variable Name
HIT4A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Communicate with a health care provider by email.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT5A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 80 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.050
Variable Name
HIT5A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Use online chat groups to learn about health topics.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SHTFLUYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 81 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.310
Variable Name
SHTFLUYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
?[F1]
DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given
in the fall and protects against influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza
vaccine sprayed in the nose.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Flu shot - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ASHFLU_M]
<2,R,D> [ goto SPRFLUYR ]
Hard Edits
Soft Edits
AssocHelp
H_SHTFLUYR
Monday, August 25, 2014
Page 82 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.310_H
Variable Name
H_SHTFLUYR
Universe
SHTFLUYR
Universe-text
Question Text
This includes a new type of flu shot called the Fluzone Intradermal vaccine that
features an ultra-fine needle that is 90 percent shorter than the typical needle used for
flu injections.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screen:
SHTFLUYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 83 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.312_1
Variable Name
ASHFLU_M
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTFLUYR(e)='1'
Universe-text
Sample adults 18+ who have had a flu shot
Question Text
1 of 2
During what month and year did you receive your most recent flu shot?
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Flu shot-month
Fill Instructions
Special Instructions
Skip Instructions
<1-12,D> [ goto ASHFLU_Y]
if PREGNOW=1 and INTERVIEW_MONTH=1-3,8-12 [goto FLUSHPG1];
else if PREGNOW=1 and INTERVIEW_MONTH=4-7 or PREGFLYR=1 [goto
FLUSHPG2];
else [goto SPRFLUYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 84 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.312_2
Variable Name
ASHFLU_Y
Universe
HHSTAT4 = 'S' and AGE GE 18 and ('01' <= ASHFLU_M <= '12','99')
Universe-text
Sample adults 18+ who gave a month for their last flu shot or who didn’t know the
month
Question Text
2 of 2
*Enter year of most recent flu shot.
Answer Codes
Question Type
Integer
Field Pane Description
Flu shot-year
Fill Instructions
Special Instructions
Skip Instructions
if PREGNOW=1 andINTERVIEW_MONTH=1-3,8-12 [goto
FLUSHPG1];
else if PREGNOW=1 and INTERVIEW_MONTH=4-7 or PREGFLYR=1 [goto
FLUSHPG2];
else [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date [goto ERR1_ASHFLU_Y]
[If ASHFLU_M and ASHFLU_Y = a date prior to birth [goto ERR2_ASHFLU_Y ]
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago [goto
ERR3_ASHFLU_Y ]
Hard Edits
ERR1_ASHFLU_Y
*Future date invalid
ERR2_ASHFLU_Y
*Date before birth
ERR3_ASHFLU_Y
*Date more than 12 months ago
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 85 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.313_00.000
Variable Name
FLUSHPG1
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and SHTFLUYR(e)='1' and
PREGNOW(e)='1' and INTERVIEW_MONTH(e) IN ('01','02','03','08','09','10','11','12')
Universe-text
Female sample adults 18-49 who are currently pregnant and are interviewed JanuaryMarch or August-December
Question Text
Did you get a flu shot before or during your current pregnancy?
Answer Codes
1. Before this pregnancy
2. During this pregnancy
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Current pregnancy flu shot
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SPRFLUYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 86 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.314_00.000
Variable Name
FLUSHPG2
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and SHTFLUYR(e)='1' and
PREGFLYR(e)='1'
Universe-text
Female sample adults 18-49 who are currently pregnant and were interviewed AprilJuly or who have been determined to be pregnant at a specific point in the past year
Question Text
[Fill1: Earlier you said you were pregnant sometime since August 1st, [last year]. Did
you
get a flu shot before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March
[current year].
Did you get a flu shot before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March
[current year].
Did you get a flu shot before, during or after this pregnancy?/
Answer Codes
1. Before this pregnancy
2. During this pregnancy
3. After this pregnancy
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Recent pregnancy flu shot
IF INTERVIEW_MONTH = 1,2,3 THEN
fill: Earlier you said you were pregnant sometime since August 1st, [fill: LASTYEAR].
Did you get a flu shot before, during or after this pregnancy?
ELSE IF INTERVIEW_MONTH = 4,5,6,7 THEN
fill: Earlier you said you were pregnant sometime between August [fill: LASTYEAR]
and March [fill: CURYEAR]. Did you get a flu shot before, during or after this
pregnancy?
ELSE
fill: Earlier you said you were pregnant sometime since August 1st, [fill: CURYEAR].
Did you get a flu shot before, during or after this pregnancy?
Special Instructions
Skip Instructions
<1-3,R,D> [goto SPRFLUYR]
Hard Edits
Soft Edits
Monday, August 25, 2014
Page 87 of 128
AssocHelp
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.315
Variable Name
SPRFLUYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by
a doctor or other health professional? A health professional may have let you spray it.
This vaccine is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Flu spray - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR
<2,D,R> [goto SHTPNUYR]
Hard Edits
Soft Edits
ERR1_SPRFLUYR
*Respondent says they have received both a flu shot and flu nasal vaccine.
*Please verify.
ERR2_SPRFLUYR
*Respondent says they have received a nasal vaccine to PREVENT the flu, not to
TREAT symptoms of the flu.
*Please verify.
AssocHelp
Monday, August 25, 2014
Page 88 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.318_1
Variable Name
ASPFLU_M
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SPRFLUYR(e)='1'
Universe-text
Sample adults 18+ who have had a flu nasal vaccine
Question Text
1 of 2
During what month and year did you receive your most recent flu nasal spray?
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Flu spray - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1-12,D> [ goto ASPFLU_Y]
[goto SHTPNUYR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 89 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.318_2
Variable Name
ASPFLU_Y
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
ASPFLU_M <= '12','99')
Universe-text
Sample adults 18+ who gave a month for their flu nasal vaccine or who didn’t know the
month
Question Text
2 of 2
*Enter year of most recent flu nasal spray.
Answer Codes
Question Type
Integer
Field Pane Description
Flu spray-year
Fill Instructions
Special Instructions
Skip Instructions
[goto SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] goto ERR1_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date prior to birth] goto ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] goto ERR3_ASPFLU_Y
Hard Edits
ERR1_ASPFLU_Y
*Future date invalid
ERR2_ASPFLU_Y
*Date before birth
ERR3_ASPFLU_Y
*Date more than 12 months ago
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 90 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.320
Variable Name
SHTPNUYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from
the flu shot. It is also called the pneumococcal vaccine.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Pneumonia shot - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APOX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 91 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.330
Variable Name
APOX
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had chickenpox?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chickenpox - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto APOX12MO]
<2,R,D> [goto AHEP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 92 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.340
Variable Name
APOX12MO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and APOX(e)='1'
Universe-text
Sample adults 18+ who have ever had chickenpox
Question Text
Have you had chickenpox in the PAST 12 MONTHS?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chickenpox - past 12 mo.
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1,2,R,D> [goto AHEP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 93 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.350
Variable Name
AHEP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had hepatitis?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Hepatitis - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHEPBTST]
<2,R,D> [goto AHEPLIV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 94 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.360
Variable Name
AHEPLIV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHEP(e)
IN('2','7','9')
Universe-text
Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
Question Text
Have you ever lived with someone who had hepatitis?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Lived w/ someone w/ hepatitis
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1,2,R,D> [goto AHEPBTST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 95 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.365_00.010
Variable Name
AHEPBTST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever had a blood test for hepatitis B?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Tested for hepatitis B
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SHTHEPB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 96 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.370
Variable Name
SHTHEPB
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available
since 1991. It is recommended for newborn infants, adolescents, and people such as
health care workers, who may be exposed to the hepatitis B virus.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Hepatitis B vaccine - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHEPDOS]
<2,R,D> [goto SHTHEPA]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 97 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.380
Variable Name
SHEPDOS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTHEPB(e) = '1'
Universe-text
Sample adults 18+ who have ever received the Hepatitis B vaccine
Question Text
Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
Answer Codes
1. Received at least 3 doses
2. Received less than 3 doses
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Hepatitis B vaccine - # of doses
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Answer name on the right.
Skip Instructions
<1,2,R,D> [goto SHTHEPA]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 98 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.390.010
Variable Name
SHTHEPA
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The hepatitis A vaccine is given as a two dose series routinely to some children starting
at 1 year of age, and to some adults and people who travel outside the United States.
Although it can be given as a combination vaccine with hepatitis B, it is different from
the hepatitis B shot, and has only been available since 1995. Have you ever received
the hepatitis A vaccine?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Had Hep A vaccine
Fill Instructions
Special Instructions
Skip Instructions
<1> goto SHEPANUM
<2,R,D> [goto AHEPCTST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 99 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.400.010
Variable Name
SHEPANUM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTHEPA(e)='1'
Universe-text
Sample adults 18+ who have had a hepatitis A vaccine
Question Text
How many hepatitis A shots did you receive?
*Enter '96' if all shots were received
Answer Codes
Question Type
Integer
Field Pane Description
Number of Hep A shots
Fill Instructions
Special Instructions
Skip Instructions
<1-95,96,R,D> [goto AHEPCTST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 100 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.405_00.010
Variable Name
AHEPCTST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever had a blood test for hepatitis C?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Tested for hepatitis C
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHEPCRES]
<2,R,D> if AGE GE 50 goto SHINGLES
elseif AGE LT 50 goto SHTTD
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 101 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.405_00.020
Variable Name
AHEPCRES
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHEPCTST(e)='1'
Universe-text
Sample adults 18+ who have had a blood test for hepatitis C
Question Text
What is the MAIN reason you were tested for hepatitis C? Was it because...
*Read answer categories below.
Answer Codes
1. You or your doctor thought you were at risk of having hepatitis C because a blood
tests or symptoms like fatigue, nausea,
stomach pain, yellowing of the eyes or skin indicated you might have liver disease?
2. You were born from 1945 through 1965
3. You were at risk of hepatitis C infection due to exposure of blood on your job,
injection drug use or receipt of transfusion before
1992
4. Some other reason
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Reason for test
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> if AGE GE 50 [goto SHINGLES];
elseif AGE LT 50 goto SHTTD
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 102 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.410.010
Variable Name
SHINGLES
Universe
HHSTAT4 = 'S' and (AGE GE '050' and AGE not IN ('997','999'))
Universe-text
Sample adults 50+
Question Text
Shingles is an outbreak of a rash or blisters on the skin that may be associated with
severe pain. The pain is generally on one side of the body or face. Shingles is caused
by the chicken pox virus. A vaccine for shingles has been available since May 2006.
Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Had shingles vaccine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto SHTTD
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 103 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.420.010
Variable Name
SHTTD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you received a tetanus shot in the past 10 years?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Had tetanus shot, past 10 years
Fill Instructions
Special Instructions
Skip Instructions
<1> goto SHTTD05
<2,R,D> and AGE >64 [goto LIVEV]
Else if <2,R,D> and AGE<65 [goto SHTHPV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 104 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.430.010
Variable Name
SHTTD05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTTD(e)='1'
Universe-text
Sample adults 18+ who have had a tetanus shot in the past 10 years
Question Text
Was your most recent tetanus shot given in 2005 or later?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Tetanus shot in 2005+
Fill Instructions
Special Instructions
Skip Instructions
<1,R> [goto SHTTDAP]
<2,D> if AGE le 64 [goto SHTHPV2]
elseif AGE gt 64 goto LIVEV
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 105 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.440.010
Variable Name
SHTTDAP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTTD05(e)
IN('1','7')
Universe-text
Sample adults who have had a tetanus shot in 2005 or beyond or refused to say if they
had a tetanus shot in 2005 or beyond
Question Text
There are currently two types of tetanus shots available today. One is the Td or
tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark) or
Boostrix (trademark). They are similar except the Tdap shot also includes a pertussis
(per-TUH-sis) or whooping cough vaccine. Thinking back to your most recent tetanus
shot, did your health care provider tell you or did the vaccine information sheet say the
vaccine included the pertussis or whooping cough vaccine? The shot is often called
Tdap or ADACEL (trademark) or BOOSTRIX (trademark).
Answer Codes
1. Yes-included pertussis
2. No-did not include pertussis
3. Doctor did not say
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Combo tetanus/pertussis shot
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if age le 64 [goto SHTHPV2];
else [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 106 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.446.010
Variable Name
SHTHPV2
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999'))
Universe-text
Sample adults age LE 64
Question Text
Have you ever received an HPV shot or vaccine?
*HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
*The vaccines are sometimes called CERVARIX (trademark) or GARDASIL
(trademark).
Answer Codes
1. Yes
2. No
3. Doctor refused when asked
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Had HPV shot
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHHPVDOS]
<2,3,R,D> [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 107 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.448.010
Variable Name
SHHPVDOS
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and SHTHPV2(e)='1'
Universe-text
Sample adults age LE 64 who have had an HPV shot
Question Text
How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots
Answer Codes
Question Type
Integer
Field Pane Description
Number of shots
Fill Instructions
Special Instructions Allow 1-50,96, Refused, Don't know
Skip Instructions
<1-50,96,R,D> [goto AHPVAGE]
<51-95> [goto ERR_SHHPVDOS]
Hard Edits
ERR_SHHPVDOS
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 108 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.449.010
Variable Name
AHPVAGE
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and SHTHPV2(e)='1'
Universe-text
Sample adults age LE 64 who have had an HPV shot
Question Text
How old were you when you received your first HPV shot?
Answer Codes
(Allow 8-current age,Refused, Don’t know)
Question Type
Integer
Field Pane Description
Age at first shot/vaccine
Fill Instructions
Special Instructions
Skip Instructions
<8-120,R,D> [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 109 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.450.010
Variable Name
LIVEV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Has a doctor or other health professional ever told you that you had any kind of chronic,
or long-term liver condition?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever had liver problems
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto TRAVEL
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 110 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.460.010
Variable Name
TRAVEL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever traveled outside of the United States to countries other than Europe,
Japan, Australia, New Zealand or Canada, since 1995?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Traveled since 1995-selected countries
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WRKHLTH]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 111 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.465.010
Variable Name
WRKHLTH
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s
office, nursing home or some other health-care facility? This includes emergency
responders and public safety personnel, part-time and unpaid work in a health care
facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative
staff, who work in a health-care facility.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Work
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto WRKDIR]
<2> [goto APSBPCHK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 112 of 128
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.470.010
Variable Name
WRKDIR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and WRKHLTH(e)='1'
Universe-text
Sample adults 18+ who work or volunteer in a health-care setting
Question Text
Do you provide direct patient care as part of your routine work? By direct patient care
we MEAN PHYSICAL OR HANDS ON CONTACT WITH PATIENTS.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Direct care
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSBPCHK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 113 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.500_00.010
Variable Name
APSBPCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+ who refused or said don’t know (in ACN) to having their blood
pressure checked in the past year
Question Text
DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a
doctor, nurse, or other health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSCHCHK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 114 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.510_00.010
Variable Name
APSCHCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+ who refused or said don’t know (in ACN) to having their blood
cholesterol checked in the past year
Question Text
DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a
doctor, nurse, or other health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSBSCHK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 115 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.520_00.010
Variable Name
APSBSCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12
MONTHS?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> and SEX=1 and AGE GE 40 [goto APSCOL]
If <1,2,R,D> and SEX=1 and AGE < 40 [goto APSDIET]
Else <1,2,R,D> and SEX=2 [goto APSPAP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 116 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.530_00.010
Variable Name
APSPAP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+
Question Text
Have you had a Pap smear or Pap test DURING THE PAST 12 MONTHS?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the
cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to
the lab.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AGE GE 30 [goto APSMAM];
else <1,2,R,D and AGE<30 [goto APSDIET]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 117 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.540_00.010
Variable Name
APSMAM
Universe
HHSTAT4 = 'S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 30+
Question Text
Have you had a Mammogram DURING THE PAST 12 MONTHS?
*Read if necessary.
A mammogram is an x-ray of each breast to look for breast cancer.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AGE GE 40 [gotoAPSCOL];
else <1,2,R,D and AGE<40> [goto APSDIET]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 118 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.550_00.010
Variable Name
APSCOL
Universe
HHSTAT4 = 'S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
DURING THE PAST 12 MONTHS, have you had any test done for colon cancer?
*Read if necessary.
Colon cancer tests include blood stool tests, colonoscopy and sigmoidoscopy.
A blood stool test is a test that may use a special kit at home to determine whether the
stool contains blood.
A sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum
to view the colon for signs of cancer or other health problems.
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSDIET]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 119 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.560_00.010
Variable Name
APSDIET
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to
you about your diet?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if SMKNOW in ('1','2') [goto APSSMKC];
else [goto AINDINS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 120 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.570_00.010
Variable Name
APSSMKC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)
IN('1','2')
Universe-text
Sample adults 18+ currently who smoke every day or some days
Question Text
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to
you about your smoking?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AINDINS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 121 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.600_00.010
Variable Name
AINDINS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 3 YEARS, did you try to purchase health insurance directly, that
is, not through any employer, union, or government program?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AINDPRCH]
<2,R,D> if age LT 65 [goto AEXCHNG];
else age GE 65 [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 122 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.600_00.020
Variable Name
AINDPRCH
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AINDINS(e)='1'
Universe-text
Sample adults 18+ who tried to purchase health insurance directly in the past 3 years
Question Text
Was a plan purchased?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AINDWHO]
<2,R,D> if age LT 65 [goto AEXCHNG]; else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 123 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.600_00.030
Variable Name
AINDWHO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AINDPRCH(e)='1'
Universe-text
Sample adults 18+ who purchased health insurance directly in the past 3 years
Question Text
Was this plan for yourself, someone else in your family, or both?
Answer Codes
1. Self
2. Someone else in family
3. Both
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto AINDDIF1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 124 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.600_00.040
Variable Name
AINDDIF1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AINDPRCH(e)='1'
Universe-text
Sample adults 18+ who purchased health insurance directly in the past 3 years
Question Text
How difficult was it to find a plan with the type of coverage you needed? Would you
say…
*Read categories below.
Answer Codes
1. Very difficult
2. Somewhat difficult
3. Not at all difficult
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto AINDDIF2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 125 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.600_00.050
Variable Name
AINDDIF2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AINDPRCH(e)='1'
Universe-text
Sample adults 18+ who purchased health insurance directly in the past 3 years
Question Text
How difficult was it to find a plan you could afford? Would you say…
*Read categories below.
Answer Codes
1. Very difficult
2. Somewhat difficult
3. Not at all difficult
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if age LT 65 [goto AEXCHNG];
else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 126 of 128
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.605_00.010
Variable Name
AEXCHNG
Universe
HHSTAT4 = 'S' and (AGE LT '065' and AGE not IN ('997','999'))
Universe-text
Sample adults LT 65 years
Question Text
Have you looked into purchasing health insurance coverage through Healthcare.gov or
the [Fill: ]?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Insurance exchange
Fill:
If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If U T then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 127 of 128
Monday, August 25, 2014
Page 128 of 128
2015 Q1 NHIS Instrument Spec Report
Section name: Adult Sexual Identity and Lifestyle Questions
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.005_00.000
Variable Name
ASIINTRO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*You are about to enter the Sexual Identity and Lifestyle questions section. This
section includes questions on computer use, the respondent’s neighborhood, sexual
identity, financial worries, mental health, and HIV testing.
*Enter 1 to Continue.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Special Instructions Do not allow don't know or refused for this screen.
Skip Instructions
<1> goto ACICPUSE
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.130_00.000
Variable Name
ACICPUSE
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These questions are about you and your neighborhood.
How often do you use a computer?
*Read answer categories.
Answer Codes
1. Never or almost never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACISATHC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.140_00.000
Variable Name
ACISATHC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In general, how satisfied are you with the health care you received in the past 12
months?
*Read answer categories.
Answer Codes
1. Very satisfied
2. Somewhat satisfied
3. Somewhat dissatisfied
4. Very dissatisfied
5. You haven’t had health care in the past 12 months
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-5,R,D> [goto ACITENUR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.150_00.000
Variable Name
ACITENUR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
About how long have you lived in your present neighborhood?
Answer Codes
1. Less than 1 year
2. 1-3 years
3. 4-10 years
4. 11-20 years
5. More than 20 years
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINHELP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.160_00.000
Variable Name
ACINHELP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How much do you agree or disagree with the following statements about your
neighborhood?
People in this neighborhood help each other out.
Would you say…
*Read answer categories.
Answer Codes
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACINCNTO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.170_00.000
Variable Name
ACINCNTO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
There are people I can count on in this neighborhood.
Would you say…
*Read answer categories if necessary.
Answer Codes
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACINTRU]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.180_00.000
Variable Name
ACINTRU
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
People in this neighborhood can be trusted.
Would you say…
*Read answer categories if necessary.
Answer Codes
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACINKNT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.190_00.000
Variable Name
ACINKNT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
This is a close-knit neighborhood.
Would you say…
*Read answer categories if necessary.
Answer Codes
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D>
[if SEX=1, goto ACISIM; elseif SEX=2, goto ACISIF]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.220_00.000
Variable Name
ACISIM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=1
Universe-text
Male sample adults 18+
Question Text
(book) ASI1
Which of the following best represents how you think of yourself?
Answer Codes
1. Gay
2. Straight, that is, not gay
3. Bisexual
4. Something else
5. I don't know the answer
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R> [goto ACIRETR]
<4> [goto ACISMELS]
<5> [goto ACISIMDK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.230_00.000
Variable Name
ACISMELS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=1 and
ACISIM(e)='4'
Universe-text
Male sample adults 18+ who think of themselves as something else
Question Text
(book) ASI3
What do you mean by something else?
Answer Codes
1. You are not straight, but identify with another label such as queer, trisexual,
omnisexual or pansexual
2. You are transgender, transsexual or gender variant
3. You have not figured out or are in the process of figuring out your sexuality
4. You do not think of yourself as having sexuality
5. You do not use labels to identify yourself
6. You mean something else
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIRETR]
<6> [goto ACIMSESP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.234_00.000
Variable Name
ACISIMDK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) ' and SEX=1 and
ACISIM(e)='5'
Universe-text
Male sample adults 18+ who answered don't know at ACISIM
Question Text
(book) ASI4
What do you mean by don't know?
Answer Codes
1. You don't understand the words
2. You understand the words, but you have not figured out or are in the process of
figuring out your sexuality
3. You mean something else
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ACIRETR]
<3> [goto ACIMSESP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.238_00.000
Variable Name
ACIMSESP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) ' and SEX=1 and
(ACISMELS(e)='6' or ACISIMDK(e)='3')
Universe-text
Male sample adults 18+ who answered something else at ACISMELS or ACISIMDK
Question Text
What do you mean by something else?
Answer Codes
Allow 75
Refused
Don't know
Question Type
Text
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
[goto ACIRETR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.240_00.000
Variable Name
ACISIF
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2
Universe-text
Female sample adults 18+
Question Text
(book) ASI2
Which of the following best represents how you think of yourself?
Answer Codes
1. Lesbian or gay
2. Straight, that is, not lesbian or gay
3. Bisexual
4. Something else
5. I don't know the answer
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R> [goto ACIRETR]
<4> [goto ACISFELS]
<5> [goto ACISIFDK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.250_00.000
Variable Name
ACISFELS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2 and
ACISIF(e)='4'
Universe-text
Female sample adults 18+ who think of themselves as as something else
Question Text
(book) ASI3
What do you mean by something else?
Answer Codes
1. You are not straight, but identify with another label such as queer, trisexual,
omnisexual or pansexual
2. You are transgender, transsexual or gender variant
3. You have not figured out or are in the process of figuring out your sexuality
4. You do not think of yourself as having sexuality
5. You do not use labels to identify yourself
6. You mean something else
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIRETR]
<6> [goto ACIFSESP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.254_00.000
Variable Name
ACISIFDK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and QTYPE='1' and
SEX=2 and ACISIF(e)='5'
Universe-text
Female sample adults 18+ who answered don’t know at ACISIF
Question Text
(book) ASI4
What do you mean by don't know?
Answer Codes
1. You don't understand the words
2. You understand the words, but you have not figured out or are in the process of
figuring out your sexuality
3. You mean something else
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ACIRETR]
<3> [goto ACIFSESP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.258_00.000
Variable Name
ACIFSESP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2 and
(ACISFELS(e)='6' or ACISIFDK(e)='3')
Universe-text
Female sample adults 18+ who answered something else at ACISFELS or ACISIFDK
Question Text
What do you mean by something else?
Answer Codes
Allow 75
Refused
Don't know
Question Type
Text
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
[goto ACIRETR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.260_00.000
Variable Name
ACIRETR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions ask how worried you are right now about financial matters.
How worried are you right now about not having enough money for retirement? Are
you…
*Read answer categories.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACIMEDC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.270_00.000
Variable Name
ACIMEDC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay medical costs of a serious
illness or accident? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACISTLV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.280_00.000
Variable Name
ACISTLV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to maintain the standard of living
you enjoy? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICNHC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.290_00.000
Variable Name
ACICNHC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay medical costs for normal
healthcare? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICCOLL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.300_00.000
Variable Name
ACICCOLL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not having enough money to pay for your
children's college? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
5. This does not apply to me
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINBILL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.310_00.000
Variable Name
ACINBILL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not having enough to pay your normal monthly
bills? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACIHCST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 22 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.320_00.000
Variable Name
ACIHCST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay your rent, mortgage, or other
housing costs? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICCMP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.330_00.000
Variable Name
ACICCMP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to make the minimum payments on
your credit cards? Are you…
*Read answer categories if necessary.
Answer Codes
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
5. I don't have credit cards
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACISLEEP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 24 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.340_00.000
Variable Name
ACISLEEP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
On average, how many hours of sleep do you get in a 24-hour period?
*Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to
the next whole hour and dropping 29 or fewer minutes.
Answer Codes
Allow 1-24, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5>[goto ERR_SLEEP];
<1-24, R,D>[goto ACISLPFL]
Hard Edits
Soft Edits
ERR_SLEEP
*Average number of hours of sleep is [ACISLEEP].
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 25 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.350_00.000
Variable Name
ACISLPFL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you have trouble falling asleep?
*Enter '0' if respondent did not have trouble falling asleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Allow 0-7, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACISLPST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 26 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.360_00.000
Variable Name
ACISLPST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you have trouble staying asleep?
*Enter '0' if respondent did not have trouble staying asleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Allow 0-7, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACISLPMD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.370_00.000
Variable Name
ACISLPMD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you take medication to help you fall asleep or
stay asleep?
*Enter '0' if respondent did not take medication to help sleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Allow 0-7, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACIREST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 28 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.380_00.000
Variable Name
ACIREST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, on how many days did you wake up feeling well rested?
*Enter '0' if respondent never felt well rested in the past week.
Answer Codes
Allow 0-7, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto MHSAD_CK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_00.000
Variable Name
MHSAD_CK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now I am going to ask you some questions about feelings you may have experienced
over the PAST 30 DAYS.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Continue
Fill Instructions
Special Instructions Do not allow Don't know or Refused.
Skip Instructions
<1> [goto ACISAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_01.000
Variable Name
ACISAD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
DURING THE PAST 30 DAYS, how often did you feel
...So sad that nothing could cheer you up?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINERV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_02.000
Variable Name
ACINERV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Nervous?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIRSTLS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_03.000
Variable Name
ACIRSTLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Restless or fidgety?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIHOPLS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_04.000
Variable Name
ACIHOPLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Hopeless?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIEFFRT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_05.000
Variable Name
ACIEFFRT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIWTHLS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 35 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.390_06.000
Variable Name
ACIWTHLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?
Answer Codes
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> if ACISAD or ACINERV or ACIRSTLS or ACIHOPLS or ACIEFFRT or
ACIWTHLS=1-3 [goto ACIMUCH];
else [goto ACIHIVT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.400_00.000
Variable Name
ACIMUCH
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (ACISAD(e)
IN('1','2','3') or ACINERV(e) IN('1','2','3') or ACIRSTLS(e) IN('1','2','3') or ACIHOPLS(e)
IN('1','2','3') or ACIEFFRT (e) IN('1','2','3') or ACIWTHLS(e) IN('1','2','3'))
Universe-text
Sample adults 18+ who at least some of the time have felt sad, nervous, restless or
fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days
Question Text
We just talked about a number of feelings you had during the PAST 30 DAYS.
Altogether, how MUCH did these feelings interfere with your life or activities: a lot,
some, a little, or not at all?
Answer Codes
1. A lot
2. Some
3. A little
4. Not at all
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACIHIVT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.410_00.000
Variable Name
ACIHIVT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next question is about the test for HIV, the virus that causes AIDS. Except for tests
you may have had as part of blood donations, have you ever been tested for HIV?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto next section]
<2> [goto ACIHIVWN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 39
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.420_00.000
Variable Name
ACIHIVWN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ACIHIVT=’2’
Universe-text
Sample adults 18+ who have never been tested for HIV
Question Text
(book) ASI6
I am going to show you a list of reasons why some people have not been tested for HIV
(the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?
Answer Codes
1. It's unlikely you've been exposed to HIV
2. You were afraid to find out if you were HIV positive (that you had HIV)
3. You didn't want to think about HIV or about being HIV positive
4. You were worried your name would be reported to the government if you tested
positive
5. You didn't know where to get tested
6. You don't like needles
7. You were afraid of losing job, insurance, housing, friends, family, if people knew you
were positive for AIDS infection
8. Some other reason
9. No particular reason
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Why not tested for HIV/AIDS
Fill Instructions
Special Instructions
Skip Instructions
<1-9,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 39
2015 Q1 NHIS Instrument Spec Report
Section name: Diet and Nutrition
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.005_00.000
Variable Name
SPSPEAK
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) CAN1
First, I would like to ask about the language you use most often. In general, what
language do you speak?
Answer Codes
1. Only Spanish
2. Mostly Spanish
3. Spanish and English about the same
4. Mostly English
5. Only English
6. Other
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Language
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto CEREALNO];
<6> [goto OTHLANG]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.006_00.000
Variable Name
OTHLANG
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SPSPEAK(e)='6'
Universe-text
Sample adults 18+ who gave other language used most often
Question Text
*Specify the language used most often.
Answer Codes
Question Type
Verbatim
Field Pane Description
Most often
Fill Instructions
Special Instructions
Skip Instructions
[goto CEREALNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.010_01.000
Variable Name
CEREALNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
These questions are about the different kinds of foods you ate or drank during the past
month, that is, the past 30 days. When answering, please include meals and snacks
eaten at home, at work or school, in restaurants, and anyplace else.
During the past month, how often did you eat HOT OR COLD CEREALS? You can tell
me per day, per week, or per month.
*Read if necessary: Include cereals eaten at any time of the day.
* Enter number.
* Enter '0' for Never.
Answer Codes
0-995,
Refused,
Don't Know
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: Include cereals eaten at any
time of the day.
Skip Instructions
<0,R,D> [goto MILKNO];
<1-995>[ [goto CEREALTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.010_02.000
Variable Name
CEREALTP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CEREALNO(e) <='995')
Universe-text
Sample adults 18+ who ate cereal in the past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (CEREALNO gt <10> and CEREALTP eq <1>) or
( CEREALNO gt <70> and CEREALTP eq <2>) or
( CEREALNO gt <310> and CEREALTP eq <3>) [goto ERR1_CEREALTP] )
Else <1-3,R,D> [goto CERTYP]
Hard Edits
Soft Edits
* [Fill1:CEREALNO] times per [Fill2: CEREALTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 4 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.015_00.000
Variable Name
CERTYP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CEREALNO(e) <='995')
Universe-text
Sample adults 18+ who ate cereal in the past month
Question Text
During the past month, what kinds of cereal did you USUALLY eat? You may choose
up to two.
* Enter the name of the cereal to locate in the lookup table.
* If second cereal is mentioned, enter 'Yes' at next screen and enter cereal name at the
following screen.
* If cereal is not found, type ZZ
Answer Codes
Question Type
Pick one or two from look-up
table
Field Pane Description
Cereal type
Fill Instructions
Special Instructions Question will use look-up table - need to combine hot and cold lists, totaling several
hundred cereals.
Skip Instructions
[goto CERTPSP];
else goto CERTYP2
All goto CERTYP2
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.015_00.010
Variable Name
CERTPSP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CERTYP='ZZ'
Universe-text
Selection in data base not found, go here to input actual response
Question Text
* Enter the other cereal as reported by the respondent.
Answer Codes
allow up to 30 characters
Don't allow 'don't know' or 'refused'
Question Type
Text
Field Pane Description
First other cereal
Fill Instructions
Special Instructions Don't allow 'don't know' or 'refused'
Skip Instructions
[goto CERTYP2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.015_01.000
Variable Name
CERTYP2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CEREALNO(e) <='995')
Universe-text
Sample adults 18+ who ate cereal in the past month
Question Text
During the past month, was there another cereal that you usually ate?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Cereal type
Fill Instructions
Special Instructions Question will use look-up table - need to combine hot and cold lists, totaling several
hundred cereals.
Skip Instructions
<1> [goto CERTYP3]
<2, D, R> [goto MILKNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.015_02.000
Variable Name
CERTYP3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CEREALNO(e) <='995')
CERTYP2(e)='1'
Universe-text
Sample adults 18+ who ate another cereal in the past month
Question Text
* Enter the name of the cereal to locate in the lookup table.
* If cereal is not found, type ZZ
Answer Codes
Question Type
Pick one or two from look-up
table
Field Pane Description
Cereal type2
Fill Instructions
Special Instructions Question will use look-up table - need to combine hot and cold lists, totaling several
hundred cereals.
Skip Instructions
[goto CERTP3SP];
else goto MILKNO
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.015_02.010
Variable Name
CERTP3SP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CERTYP3='ZZ'
Universe-text
Selection in data base not found, go here to input actual response
Question Text
* Enter the other cereal as reported by the respondent.
Answer Codes
allow up to 30 characters
Don't allow 'don't know' or 'refused'
Question Type
Text
Field Pane Description
Second other cereal
Fill Instructions
Special Instructions Don't allow 'don't know' or 'refused'
Skip Instructions
[goto MILKNO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.020_01.000
Variable Name
MILKNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you have MILK, either to drink or on cereal? Do NOT include soy milk or
small amounts of milk in coffee or tea.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto SODANO];
<1-995> [goto MILKTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.020_02.000
Variable Name
MILKTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
MILKNO(e) <='995')
Universe-text
Sample adults 18+ who drank milk in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick one - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (MILKNO gt <10> and MILKTP eq <1>) or
(MILKNO gt <70> and MILKTP eq <2>) or
( MILKNO gt <310> and MILKTP eq <3>) [goto ERR1_MILKTP] )
Else <1-3,R,D> [goto MILKTYP]
Hard Edits
Soft Edits
* [Fill1:MILKNO] times per [Fill2: MILKTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 11 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.025_00.000
Variable Name
MILKTYP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
MILKNO(e) <='995')
Universe-text
Sample adults 18+ who drank milk in past month
Question Text
What type of milk was it? Was it usually…
* Read categories below.
* If respondent drinks soy milk only, go back and change MILKNO to '0'.
Answer Codes
1. Whole or regular milk
2. 2% fat or reduced-fat milk
3. 1% fat or low-fat milk (includes 0.5% fat milk or "low-fat" milk no further specified)
4. Fat-free, skim or nonfat milk
5. Other
Refused
Don't know
Question Type
Pick one - answer list pane
Field Pane Description
Milk type
Fill Instructions
Special Instructions Bold Black Answer Codes to be read.
Skip Instructions
<1-6,R,D> [goto SODANO]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.030_01.000
Variable Name
SODANO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
During the past month, how often did you drink REGULAR SODA or pop that contains
sugar? Do NOT include diet soda. You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<0,R,D> [goto FRJUICNO];
<1-995>[goto SODATP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.030_02.000
Variable Name
SODATP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
SODANO(e) <='995')
Universe-text
Sample adults 18+ who drank soda in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (SODANO gt <10> and SODATP eq <1>) or
(SODANO gt <70> and SODATP eq <2>) or
( SODANO gt <310> and SODATP eq <3>) [goto ERR1_SODATP] )
Else <1-3,R,D> [goto FRTJUICNO]
Hard Edits
Soft Edits
* [Fill1:SODANO] times per [Fill2: SODATP ] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 14 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.040_01.000
Variable Name
FRJUICNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you drink 100% PURE fruit juice such as orange, mango, apple, grape
and pineapple juices? Do NOT include fruit flavored drinks with added sugar or fruit
juice you made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto COFFEEN1];
<1-995>[goto FRJUICTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.040_02.000
Variable Name
FRJUICTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
FRJUICNO(e) <='995')
Universe-text
Sample adults 18+ who drank fruit juice in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (FRJUICNO gt <10> and FRJUICTP eq <1>) or
(FRJUICNO gt <70> and FRJUICTP eq <2>) or
( FRJUICNO gt <310> and FRJUICTP eq <3>) [goto ERR1_FRJUICTP] )
Else <1-3,R,D>[goto COFFEEN1]
Hard Edits
Soft Edits
* [Fill1:FRJUICNO] times per [Fill2: FRJUICTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 16 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.042_01.000
Variable Name
COFFEEN1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month
How often did you drink COFFEE or tea that had sugar or honey added to it? Include
coffee and tea you sweetened yourself and presweetened tea and coffee drinks such
as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or
diet tea.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto SPORDRNO];
<1-995> [goto COFFEET1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.042_02.000
Variable Name
COFFEET1
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
COFFEEN1(e) <='995')
Universe-text
Sample adults 18+ who drank coffee in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (COFFEEN1 gt <10> and COFFEET1 eq <1>) or
(COFFEEN1 gt <70> and COFFEET1 eq <2>) or
( COFFEEN1 gt <310> and COFFEET1 eq <3>) [goto ERR1_COFFEET1] )
Else <1-3,R,D> [goto SPORDRNO]
Hard Edits
Soft Edits
* [Fill1:COFFEEN1] times per [Fill2: COFFEET1] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 18 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.045_01.000
Variable Name
SPORDRNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you drink SPORTS and ENERGY drinks such as Gatorade, Red Bull,
and Vitamin water?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto FRTDRNO];
<1-995> [goto SPORDRTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.045_02.000
Variable Name
SPORDRTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
SPORDRNO(e) <='995')
Universe-text
Sample adults 18+ who drank sports drink in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (SPORDRNO gt <10> and SPORDRTP eq <1>) or
(SPORDRNO gt <70> and SPORDRTP eq <2>) or
( SPORDRNO gt <310> and SPORDRTP eq <3>) [goto ERR1_SPORDRTP] )
Else <1-3,R,D> [goto FRTDRNO]
Hard Edits
Soft Edits
* [Fill1:SPORDRNO] times per [Fill2: SPORDRTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 20 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.060_01.000
Variable Name
FRTDRNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you drink sweetened fruit drinks, such as Kool-aid, cranberry and
lemonade? Include fruit drinks you made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto FRUITNO];
<1-995> [goto FRTDRTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.060_02.000
Variable Name
FRTDRTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
FRTDRNO(e) <='995')
Universe-text
Sample adults 18+ who drank fruit drinks in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if ( FRTDRNO gt <10> and FRTDRTP eq <1>) or
(FRTDRNO gt <70> and FRTDRTP eq <2>) or
( FRTDRNO gt <310> and FRTDRTP eq <3>) [goto ERR1_FRTDRTP] )
Else <1-3,R,D> [goto FRUITNO]
Hard Edits
Soft Edits
* [Fill1:FRTDRNO] times per [Fill2: FRTDRTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 22 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.070_01.000
Variable Name
FRUITNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat FRUIT? Include fresh, frozen, or canned fruit. Do NOT include
juices.
*Read if necessary: You can tell me per day, per week, or per month.
.* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto SALADNO];
<1-995> [goto FRUITTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.070_02.000
Variable Name
FRUITTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
FRUITNO(e) <='995')
Universe-text
Sample adults 18+ who ate fruit in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (FRUITNO gt <10> and FRUITTP eq <1>) or
(FRUITNO gt <70> and FRUITTP eq <2>) or
(FRUITNO gt <310> and FRUITTP eq <3>) [goto ERR1_FRUITTP] )
Else <1-3,R,D> [goto SALADNO]
Hard Edits
Soft Edits
* [Fill1:FRUITNO] times per [Fill2: FRUITTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 24 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.090_01.000
Variable Name
SALADNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . .
How often did you eat a green leafy or lettuce SALAD, with or without other vegetables?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto FRIESNO];
<1-995> [goto SALADTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.090_02.000
Variable Name
SALADTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
SALADNO(e) <='995')
Universe-text
Sample adults 18+ who ate salad in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (SALADNO gt <10> and SALADTP eq <1>) or
(SALADNO gt <70> and SALADTP eq <2>) or
(SALADNO gt <310> and SALADTP eq <3>) [goto ERR1_SALADTP] )
Else <1-3,R,D> [goto FRIESNO]
Hard Edits
Soft Edits
* [Fill1:SALADNO] times per [Fill2: SALADTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 26 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.100_01.000
Variable Name
FRIESNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of FRIED POTATOES, including French fries, home
fries, or hash brown potatoes?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto POTATONO];
<1-995> [goto FRIESTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.100_02.000
Variable Name
FRIESTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
FRIESNO(e) <='995')
Universe-text
Sample adults 18+ who ate fried potatoes in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (FRIESNO gt <10> and FRIESTP eq <1>) or
(FRIESNO gt <70> and FRIESTP eq <2>) or
(FRIESNO gt <310> and FRIESTP eq <3>) [goto ERR1_FRIESTP] )
Else <1-3,R,D> [goto POTATONO]
Hard Edits
Soft Edits
* [Fill1:FRIESNO] times per [Fill2: FRIESTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 28 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.110_01.000
Variable Name
POTATONO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any OTHER KIND OF POTATOES, such as baked, boiled,
mashed potatoes, sweet potatoes, or potato salad?
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE red-skinned and Yukon Gold potatoes.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto BEANSNO];
<1-995> [goto POTATOTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.110_02.000
Variable Name
POTATOTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
POTATONO(e) <='995')
Universe-text
Sample adults 18+ who ate other potatoes in the past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (POTATONO gt <10> and POTATOTP eq <1>) or
(POTATONO gt <70> and POTATOTP eq <2>) or
(POTATONO gt <310> and POTATOTP eq <3>) [goto ERR1_POTATOTP] )
Else <1-3,R,D> [goto BEANSNO]
Hard Edits
Soft Edits
* [Fill1:POTATONO] times per [Fill2: POTATOTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 30 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.120_01.000
Variable Name
BEANSNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat refried beans, baked beans, beans in soup, pork and beans or
any other type of cooked dried beans? Do NOT include green beans.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto BRRICENO];
<1-995> [goto BEANSTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.120_02.000
Variable Name
BEANSTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
BEANSNO(e) <='995')
Universe-text
Sample adults 18+ who ate beans in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (BEANSNO gt <10> and BEANSTP eq <1>) or
(BEANSNO gt <70> and BEANSTP eq <2>) or
(BEANSNO gt <310> and BEANSTP eq <3>) [goto ERR1_BEANSTP] )
Else <1-3,R,D> [goto BRRICENO]
Hard Edits
Soft Edits
* [Fill1:BEANSNO] times per [Fill2: BEANSNO] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 32 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.125_01.000
Variable Name
BRRICENO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat BROWN RICE or other cooked whole grains, such as bulgur,
cracked wheat, or millet? Do NOT include white rice.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto OVEGNO];
<1-995> [goto BRRICETP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.125_02.000
Variable Name
BRRICETP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
BRRICENO(e) <='995')
Universe-text
Sample adults 18+ who ate brown rice in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (BRRICENO gt <10> and BRRICETP eq <1>) or
(BRRICENO gt <70> and BRRICETP eq <2>) or
(BRRICENO gt <310> and BRRICETP eq <3>) [goto ERR1_BRRICETP] )
Else <1-3,R,D> [goto OVEGNO]
Hard Edits
Soft Edits
* [Fill1:BRRICENO] times per [Fill2: BRRICETP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 34 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.130_01.000
Variable Name
OVEGNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
Not including what you just told me about (lettuce salads, potatoes, cooked dried
beans), how often did you eat OTHER VEGETABLES?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto SALSANO];
<1-995> [goto OVEGTP]
Hard Edits
Soft Edits
AssocHelp
H_OVEGNO
Monday, August 25, 2014
Page 35 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.130_01.000_H
Variable Name
H_OVEGNO
Universe
Universe-text
Question Text
COUNT any form of the vegetable (raw, cooked, canned, or frozen).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: OVEGNO
Skip Instructions
<0,R,D> [goto SALSANO];
<1-995> [goto OVEGTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.130_02.000
Variable Name
OVEGTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
OVEGNO(e) <='995')
Universe-text
Sample adults 18+ who ate other vegetables in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (OVEGNO gt <10> and OVEGTP eq <1>) or
(OVEGNO gt <70> and OVEGTP eq <2>) or
(OVEGNO gt <310> and OVEGTP eq <3>) [goto ERR1_OVEGTP] )
Else <1-3,R,D> [goto SALSANO]
Hard Edits
Soft Edits
* [Fill1:OVEGNO] times per [Fill2: OVEGTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 37 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.131_01.000
Variable Name
SALSANO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you have Mexican-type SALSA made with tomato?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto PIZZANO];
<1-995> [goto SALSATP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.131_02.000
Variable Name
SALSATP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
SALSANO(e) <='995')
Universe-text
Sample adults 18+ who ate salsa in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (SALSANO gt <10> and SALSATP eq <1>) or
(SALSANO gt <70> and SALSATP eq <2>) or
(SALSANO gt <310> and SALSATP eq <3>) [goto ERR1_SALSATP] )
Else <1-3,R,D> [goto PIZZANO]
Hard Edits
Soft Edits
* [Fill1:SALSANO] times per [Fill2: SALSATP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 39 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.132_01.000
Variable Name
PIZZANO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat PIZZA? Include frozen pizza, fast food pizza, and homemade
pizza. You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Skip Instructions
<0,R,D> [goto TOMSAUNO];
<1-995> [goto PIZZATP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.132_02.000
Variable Name
PIZZATP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
PIZZANO(e) <='995')
Universe-text
Sample adults 18+ who ate pizza in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (PIZZANO gt <10> and PIZZATP eq <1>) or
(PIZZANO gt <70> and PIZZATP eq <2>) or
(PIZZANO gt <310> and PIZZATP eq <3>) [goto ERR1_PIZZATP] )
Else <1-3,R,D> [goto TOMSAUNO]
Hard Edits
Soft Edits
* [Fill1:PIZZANO] times per [Fill2: PIZZATP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 41 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.133_01.000
Variable Name
TOMSAUNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you have TOMATO SAUCES such as with spaghetti or noodles or mixed
into foods such as lasagna? Do not include tomato sauce on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto CHEESENO];
<1-995> [goto TOMSAUTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.133_02.000
Variable Name
TOMSAUTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
TOMSAUNO(e) <='995')
Universe-text
Sample adults 18+ who ate tomoto sauces in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (TOMSAUNO gt <10> and TOMSAUTP eq <1>) or
(TOMSAUNO gt <70> and TOMSAUTP eq <2>) or
(TOMSAUNO gt <310> and TOMSAUTP eq <3>) [goto ERR1_TOMSAUTP] )
Else <1-3,R,D> [goto CHEESENO]
Hard Edits
Soft Edits
* [Fill1:TOMSAUNO] times per [Fill2: TOMSAUTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 43 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.134_01.000
Variable Name
CHEESENO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of CHEESE? Include cheese as a snack, cheese on
burgers, sandwiches, and cheese in foods such as lasagna, quesadillas, or
casseroles. Do not include cheese on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto REDMETNO];
<1-995> [goto CHEESETP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.134_02.000
Variable Name
CHEESETP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CHEESENO(e) <='995')
Universe-text
Sample adults 18+ who ate cheese in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (CHEESENO gt <10> and CHEESETP eq <1>) or
(CHEESENO gt <70> and CHEESETP eq <2>) or
(CHEESENO gt <310> and CHEESETP eq <3>) [goto ERR1_CHEESETP] )
Else <1-3,R,D> [goto REDMETNO]
Hard Edits
Soft Edits
* [Fill1:CHEESENO] times per [Fill2: CHEESETP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 45 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.136_01.000
Variable Name
REDMETNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) CAN2
1 of 2
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat RED MEAT, such as beef, pork, ham, or
sausage? Do NOT include chicken, turkey, or seafood.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
INFORMATIONAL PURPOSE ONLY ABOUT THE FLASHCARD:
EXAMPLES OF RED MEAT
Beef
Veal
Pork
Bacon
Ham
Lamb
Hotdogs and cold cuts
made with red meats
Include:
Sandwiches
Lasagna
Stew
Pizza
Hamburgers
Skip Instructions
} made with red meats
<0,R,D> [goto PROMETNO];
<1-995> [goto REDMETTP]
Monday, August 25, 2014
Page 46 of 70
Hard Edits
Soft Edits
AssocHelp
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.136_02.000
Variable Name
REDMETTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
REDMETNO(e) <='995')
Universe-text
Sample adults 18+ who ate red meat in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (REDMETNO gt <10> and REDMETTP eq <1>) or
(REDMETNO gt <70> and REDMETTP eq <2>) or
(REDMETNO gt <310> and REDMETTP eq <3>) [goto ERR1_REDMETTP] )
Else <1-3,R,D> [goto PROMETNO]
Hard Edits
Soft Edits
* [Fill1:REDMETNO] times per [Fill2: REDMETTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 47 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.137_01.000
Variable Name
PROMETNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
(book) CAN3
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat PROCESSED MEAT, such as bacon, lunch
meats, or hot dogs?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
INFORMATIONAL PURPOSE ONLY ABOUT THE FLASHCARD:
CARD CAN3
EXAMPLES OF PROCESSED MEAT
Cold cuts
Luncheon meats
Hotdogs
Bacon
Ham
Pastrami
Salami
Sausages
Bratwursts
Corned beef
Include:
Sandwiches
Soups
Pizza
Monday, August 25, 2014
} made with those meats
Page 48 of 70
Casseroles
Skip Instructions
<0,R,D> [goto BREADNO];
<1-995> [goto PROMETTP]
Hard Edits
Soft Edits
AssocHelp
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.137_02.000
Variable Name
PROMETTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
PROMETNO(e) <='995')
Universe-text
Sample adults 18+ who ate processed meat in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (PROMETNO gt <10> and PROMETTP eq <1>) or
(PROMETNO gt <70> and PROMETTP eq <2>) or
(PROMETNO gt <310> and PROMETTP eq <3>) [goto ERR1_PROMETTP] )
Else <1-3,R,D> [goto BREADNO]
Hard Edits
Soft Edits
* [Fill1:PROMETNO] times per [Fill2: PROMETTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 49 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.138_01.000
Variable Name
BREADNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat WHOLE GRAIN BREAD including toast, rolls and in
sandwiches? Whole grain breads include whole wheat, rye, oatmeal and
pumpernickel. Do NOT include white bread.
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE cracked wheat, multi-grain and bran breads.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto CANDYNO];
<1-995> [goto BREADTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.138_02.000
Variable Name
BREADTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
BREADNO(e) <='995')
Universe-text
Sample adults 18+ who ate whole grain bread in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (BREADNO gt <10> and BREADTP eq <1>) or
(BREADNO gt <70> and BREADTP eq <2>) or
(BREADNO gt <310> and BREADTP eq <3>) [goto ERR1_BREADTP] )
Else <1-3,R,D> [goto CANDYNO]
Hard Edits
Soft Edits
* [Fill1:BREADNO] times per [Fill2: BREADTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 51 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.139_01.000
Variable Name
CANDYNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat CHOCOLATE, or any other types of CANDY? Do NOT include
SUGAR-FREE CANDY. You can tell me per day, per week or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Skip Instructions
<0,R,D> [goto DONUTNO];
<1-995> [goto CANDYTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.139_02.000
Variable Name
CANDYTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
CANDYNO(e) <='995')
Universe-text
Sample adults 18+ who ate candy in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (CANDYNO gt <10> and CANDYTP eq <1>) or
(CANDYNO gt <70> and CANDYTP eq <2>) or
(CANDYNO gt <310> and CANDYTP eq <3>) [goto ERR1_CANDYTP] )
Else <1-3,R,D> [goto DONUTNO]
Hard Edits
Soft Edits
* [Fill1:CANDYNO] times per [Fill2: CANDYTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 53 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.140_01.000
Variable Name
DONUTNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat DOUGHNUTS, sweet rolls, Danish, muffins, (pan dulce) or poptarts? Do NOT include sugar-free items.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto COOKIENO];
<1-995> [goto DONUTTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.140_02.000
Variable Name
DONUTTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
DONUTNO(e) <='995')
Universe-text
Sample adults 18+ who ate donuts in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (DONUTNO gt <10> and DONUTTP eq <1>) or
(DONUTNO gt <70> and DONUTTP eq <2>) or
(DONUTNO gt <310> and DONUTTP eq <3>) [goto ERR1_DONUTTP] )
Else <1-3,R,D> [goto COOKIENO]
Hard Edits
Soft Edits
* [Fill1:DONUTNO] times per [Fill2: DONUTTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 55 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.141_01.000
Variable Name
COOKIENO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat COOKIES, CAKE, PIE, or BROWNIES? Do NOT include sugarfree kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto ICECRNO];
<1-995> [goto COOKIETP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.141_02.000
Variable Name
COOKIETP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
COOKIENO(e) <='995')
Universe-text
Sample adults 18+ who ate cookies in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (COOKIENO gt <10> and COOKIETP eq <1>) or
(COOKIENO gt <70> and COOKIETP eq <2>) or
(COOKIENO gt <310> and COOKIETP eq <3>) [goto ERR1_COOKIETP] )
Else <1-3,R,D> [goto ICECRNO]
Hard Edits
Soft Edits
* [Fill1:COOKIENO] times per [Fill2: COOKIETP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 57 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.145_01.000
Variable Name
ICECRNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat ICE CREAM OR OTHER FROZEN DESSERTS? Do NOT
include sugar-free kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto POPCNNO];
<1-995> [goto ICECRTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.145_02.000
Variable Name
ICECRTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
ICECRNO(e) <='995')
Universe-text
Sample adults 18+ who ate ice cream in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (ICECRNO gt <10> and ICECRTP eq <1>) or
(ICECRNO gt <70> and ICECRTP eq <2>) or
(ICECRNO gt <310> and ICECRTP eq <3>) [goto ERR1_ICECRTP] )
Else <1-3,R,D> [goto POPCNNO]
Hard Edits
Soft Edits
* [Fill1:ICECRNO] times per [Fill2: ICECRTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 59 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.150_01.000
Variable Name
POPCNNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
*Read if necessary: During the past month . . .
How often did you eat POPCORN?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: During the past month . . .
Display the text in BOLD GRAY for the FR instruction: You can tell me per day, per
week, or per month.
Skip Instructions
<0,R,D> [goto VITMIN];
<1-995> [goto POPCNTP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.150_02.000
Variable Name
POPCNTP
Universe
(HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001' <=
POPCNNO(e) <='995')
Universe-text
Sample adults 18+ who ate popcorn in past month
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
[if (POPCNNO gt <10> and POPCNTP eq <1>) or
(POPCNNO gt <70> and POPCNTP eq <2>) or
(POPCNNOO gt <310> and POPCNTP eq <3>) [goto ERR1_POPCNTP] )
Else <1-3,R,D> [goto VITMIN]
Hard Edits
Soft Edits
* [Fill1:POPCNNO] times per [Fill2: POPCNTP] is unusually high.
* Please verify.
AssocHelp
Monday, August 25, 2014
Page 61 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.170_00.000
Variable Name
VITMIN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about vitamins and minerals you may have taken during the
past month, that is, the past 30 days.
DURING THE PAST MONTH, did you take any vitamin or mineral pills or supplements
of ANY kind?
*Read if necessary: INCLUDE vitamin or mineral pills or liquids. Do NOT include
vitamin-fortified foods.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Vitamins
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: INCLUDE vitamin or mineral pills
or liquids. Do NOT include vitamin-fortified foods.
Skip Instructions
<1> [goto VITMULT]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.180_00.000
Variable Name
VITMULT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITMIN(e)='1'
Universe-text
Sample adults 18+ who have taken vitamins or mineral supplements in the past month
Question Text
DURING THE PAST MONTH, did you take any MULTI-vitamins such as One-A-Day,
Theragran, or Centrum?
*Read if necessary: Include combinations of three or more vitamins and minerals, such
as those labeled "stress" or "anti-oxidant". Do not include combinations of herbal or
plant substances, or combinations of just two, like calcium and vitamin D.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Multi-vitamins
Fill Instructions
Special Instructions Display the text in BOLD GRAY for the FR instruction: Include combinations of three or
more vitamins and minerals, such as those labeled "stress" or "anti-oxidant". Do not
include combinations of herbal or plant substances, or combinations of just two, like
calcium and vitamin D.
Skip Instructions
<1> [goto VITMULD]
<2,R,D> [goto CALCA]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.200_01.000
Variable Name
VITMULD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITMULT(e)='1'
Universe-text
Sample adults 18+ who have taken a multi-vitamin in the past month
Question Text
On how many DAYS during the past month did you take a MULTI-vitamin?
*Enter number of days taking multi-vitamins.
*Enter '30' for all days in the month.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-30, R, D> [goto CALCA]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.210_00.000
Variable Name
CALCA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITMIN(e)='1'
Universe-text
Sample adults 18+ who have taken vitamins or mineral supplements in the past month
Question Text
DURING THE PAST MONTH, did you take any CALCIUM SUPPLEMENTS, including
Tums or calcium chews? [Fill1: Do NOT include any calcium in the MULTI-vitamins
you told me about.]
*Read if necessary: Do NOT include milk or calcium-fortified orange juice.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Calcium
Fill1: {If VITMULT=1}, fill "Do NOT include any calcium in the MULTI-vitamins you told
me about."
Special Instructions Display the text in BOLD GRAY for the FR instruction: Do NOT include milk or calciumfortified orange juice.
Skip Instructions
<1> [goto CALCD]
<2,R,D> [goto VITD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 65 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.215_01.000
Variable Name
CALCD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CALC(e)='1'
Universe-text
Sample adults 18+ who have taken calcium in the past month
Question Text
1 of 2
On how many DAYS during the past month did you take calcium supplements?
*Enter number of days taking calcium.
*Enter '30' for all days in the month.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-30, R, D> [goto VITD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 66 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.270_00.000
Variable Name
VITD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITMIN(e)='1'
Universe-text
Sample adults 18+ who have taken vitamin or mineral supplements in the past month
Question Text
DURING THE PAST MONTH, did you take any VITAMIN D PILLS OR
SUPPLEMENTS?
Fill1: [Do NOT include any vitamin D in the MULTI-vitamins you told me about.]
Fill2: [Do NOT include calcium supplements that contain vitamin D.]
Fill3: [Do not include calcium supplements that contain vitamin D or MULTI-vitamins
you told me about.]
*Read if necessary: Do NOT include vitamin D fortified milk or other foods such as
cereals and bread.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Vitamin D
Fill1: If VITMULT=1 and CALCA=2,R,D fill [Do NOT include any vitamin D in the
MULTI-vitamins you told me about.]
Fill2: If CALCA=1 and VITMULT=2,R,D fill [Do NOT include calcium supplements that
contain vitamin D.]
Fill3: If VITMULT=1 and CALCA=1 fill [Do not include calcium supplements that contain
vitamin D or MULTI-vitamins you told me about.]
Special Instructions Display the text in BOLD GRAY for the FR instruction: Do NOT include vitamin D
fortified milk or other foods such as cereals and bread.
Skip Instructions
<1> [goto VITDM]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 67 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.280_00.000
Variable Name
VITDM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITD(e)='1'
Universe-text
Sample adults 18+ who have taken vitamin D in the past month
Question Text
On how many DAYS during the past month did you take vitamin D?
*Enter '30' for all days in the month.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-30, R, D> [goto VITDWHY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 68 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.290_01.000
Variable Name
VITDWHY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITD(e)='1'
Universe-text
Sample adults 18+ who have taken vitamin D in the past month
Question Text
Which of these is the MAIN reason you took vitamin D…?
*Read categories below.
Answer Codes
1. For OVERALL health
2. For BONE health
3. To prevent CANCER
4. For some other reason
Refused
Don't know
Question Type
Pick One- answer pane list
Field Pane Description
Reason
Fill Instructions
Special Instructions Display answer categories 1-4 in BOLD BLACK text.
Skip Instructions
<1-3, R,D>[goto next section]
<4> [goto VITDSPEC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 69 of 70
Module
27
Section Name
Diet and Nutrition
Part
Question ID
NAC.300_00.000
Variable Name
VITDSPEC
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VITDWHY(e)='4'
Universe-text
Sample adults 18+ who gave other reason for taking vitamin D
Question Text
*Specify the reason took vitamin D.
Answer Codes
Question Type
Verbatim
Field Pane Description
Reason
Fill Instructions
Special Instructions
Skip Instructions
[goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 70 of 70
2015 Q1 NHIS Instrument Spec Report
Section name: Physical Activity
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.010_00.000
Variable Name
AD11A
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions are about walking for transportation. I will ask you separately about
walking for other reasons like relaxation or exercise.
During the past 7 days, did you walk to get some place that took you at least 10
minutes?
Answer Codes
1. Yes
2. No
3. Unable to walk
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Walk-transportation
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AD12A]
<2,R,D> [goto AD14A]
<3> [goto PAHOME]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.011_00.000
Variable Name
AD12A
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AD11A(e)='1'
Universe-text
Sample adults 18+ who have walked for transportation in the past 7 days
Question Text
In the past 7 days, how many times did you do that?
*Read if necessary: Walk for at least 10 minutes to get some place.
Answer Codes
Allow 1-94,R,D
Question Type
Integer
Field Pane Description
Frequency
Fill Instructions
Special Instructions
Skip Instructions
<1-94> [goto AD13ANO]
[goto AD14A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.012_01.000
Variable Name
AD13ANO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
AD12A(e)<= '94')
Universe-text
Sample adults 18+ who have walked for transportation at least once in the past week
Question Text
1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for transportation.
Answer Codes
Allow 1-995,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Number
if AD12A=1, Fill1: "How long did that walk take?";
else if AD12A gt 1, Fill2: "On average, how long did those walks take?"
Special Instructions
Skip Instructions
<1-995>[goto AD13ATP]
[If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP]
[goto AD14A]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.012_02.000
Variable Name
AD13ATP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
AD12A(e)<= '94')
Universe-text
Sample adults 18+ who have walked for transportation at least once in the past week
and gave a number for the first part of this two-part question
Question Text
2 of 2
* Enter time period for length of walking for transportation.
Answer Codes
1. Minutes
2. Hours
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
If AD13ANO gt <24> and AD13ATP eq <2> [goto ERR1_ AD13ATP]
(IF AD13ANO gt <90> and AD13ATP eq <1> ) or ( if AD13ANO gt <2> and AD13ATP
eq <2> ) [goto ERR2_ AD13ATP]
<1,2,R,D> [goto AD14A] and
If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.013_00.000
Variable Name
AD14A
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AD11A(e) NE '3'
Universe-text
Sample adults 18+ who are able to walk
Question Text
Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the
past 7 days, did you walk for at least 10 minutes for any of these reasons? Please do
not include walking for transportation.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Walk-leisure
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AD15A]
<2,R,D> [goto PAHOME]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.014_00.000
Variable Name
AD15A
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AD14A(e)='1'
Universe-text
Sample adults 18+ who have walked for leisure in the past 7 days
Question Text
In the past 7 days, how many times did you do that?
Answer Codes
Allow 1-94,R,D
Question Type
Integer
Field Pane Description
Frequency
Fill Instructions
Special Instructions
Skip Instructions
<1-94> [goto AD16ANO]
[goto PAHOME]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.015_01.000
Variable Name
AD16ANO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
AD15A(e)<= '94')
Universe-text
Sample Adults 18+ who have walked for leisure at least once in the past week.
Question Text
1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for fun, relaxation, or exercise.
Answer Codes
Allow 1-995,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Number
if AD15A=1, Fill1: "How long did that walk take?"
else if AD15A gt 1, Fill2: "On average, how long did those walks take?"
Special Instructions
Skip Instructions
<1-995>[goto AD16ATP]
[goto PAHOME] and [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.015_02.000
Variable Name
AD16ATP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
AD15A(e)<= '94')
Universe-text
Sample adults 18+ who have walked for leisure at least once in the past week and gave
a number for the first part of this two-part question
Question Text
2 of 2
* Enter time period for length of walking for fun, relaxation, or exercise.
Answer Codes
1. Minutes
2. Hours
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
If AD16ANO gt <24> and AD16ATP eq <2> [goto ERR1_ AD16ATP]
(IF AD16ANO gt <90> and AD16ATP eq <1> ) or ( if AD16ANO gt <2> and AD16ATP
eq <2> ) [goto ERR2_ AD16ATP]
<1,2,R,D>[goto PAHOME]; [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.020_00.000
Variable Name
PAHOME
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How often are there people walking within sight of your home? Would you say…
*Read categories below.
Answer Codes
1. Every day
2. Every 2-3 days
3. About once a week
4. Less than once a week
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Walking near home
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto PAWTHR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.025_00.000
Variable Name
PAWTHR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How often does the weather make you less likely to walk? Would you say…
*Read if necessary: We mean any kind of bad weather that makes you less likely to
walk, such as hot, cold, rainy, snowy, and windy.
Answer Codes
1. Almost always
2. Most of the time
3. Some of the time
4. A little of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Weather
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto PAROAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.030_00.000
Variable Name
PAROAD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions are about where you live.
*Read if necessary: These questions are about your walking or places you can walk,
not walking by other people.
Where you live, are there roads, sidewalks, paths or trails where you can walk?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Roads
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PASHOPS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.035_00.000
Variable Name
PASHOPS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Are there shops, stores, or markets that you can walk to?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Shops
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PATRANS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.040_00.000
Variable Name
PATRANS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Are there bus or transit stops that you can walk to?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Public transportation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PAMOVIE]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.045_00.000
Variable Name
PAMOVIE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Are there places like movies, libraries, or churches that you can walk to?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Movies
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PARELAX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.050_00.000
Variable Name
PARELAX
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Are there places that you can walk to that help you relax, clear your mind, and reduce
stress?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Relax
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PASIDEW]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.055_00.000
Variable Name
PASIDEW
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Do most streets have sidewalks?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Sidewalks
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PATRAFF]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.060_00.000
Variable Name
PATRAFF
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Does traffic makes it unsafe for you to walk?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Traffic
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PACRIME]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.065_00.000
Variable Name
PACRIME
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Does crime make it unsafe for you to walk?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Crime
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PAANIMAL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 19
Module
28
Section Name
Physical Activity
Part
Question ID
NAD.070_00.000
Variable Name
PAANIMAL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary: Where you live…
Do dogs or other animals make it unsafe for you to walk?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Animals
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 19
2015 Q1 NHIS Instrument Spec Report
Section name: Tobacco
Module
29
Section Name
Tobacco
Part
Question ID
NAE.010_00.000
Variable Name
MENTHOLF
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e)='3'
Universe-text
Sample adults 18+ who are former smokers
Question Text
Earlier you said you used to smoke cigarettes. Think back to the 12 months BEFORE
you quit smoking. During that time, was your usual cigarette brand menthol or nonmenthol?
Answer Codes
1. Menthol
2. Non-menthol
3. No usual type
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if SMKREG ne '96' [goto NUMCIGA];
else if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.015_00.000
Variable Name
NUMCIGA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e)='3' and SMKREG(e) ne '96'
Universe-text
Sample adults 18+ who are former smokers and had smoked regularly in the past
Question Text
When you last smoked FAIRLY REGULARLY, how many cigarettes did you usually
smoke per day?
*Enter '95' if varied.
*Enter '96' if never smoked cigarettes regularly.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-94,96,R,D> if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]
<95> [goto NUMCVAR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.017_00.000
Variable Name
NUMCVAR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and NUMCIGA(e)='95'
Universe-text
Sample adults 18+ who said number of cigarettes smoked daily varied
Question Text
What is the average number of cigarettes that you smoked daily during the longest
period that you smoked?
*Read if necessary: 1 pack equals 20 cigarettes.
*Enter '95' if 95 or more.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-95,R,D> if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.020_01.000
Variable Name
FQUITA_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
Thinking back to when you stopped smoking completely, did you use ANY of the
following PRODUCTS:
A nicotine patch?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITA_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.020_02.000
Variable Name
FQUITA_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the
following PRODUCTS:
A nicotine gum or lozenge (LA-zenj)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITA_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.020_03.000
Variable Name
FQUITA_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the
following PRODUCTS:
A nicotine containing nasal spray or inhaler?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITA_4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.020_04.000
Variable Name
FQUITA_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the
following PRODUCTS:
A prescription pill called Chantix (CHAN-tix) or Varenicline (vuh-REN-ih-klin)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITA_5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.025_01.000
Variable Name
FQUITB_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
Thinking back to when you stopped smoking completely, did you use ANY of the
following:
A telephone help line or quit line?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITB_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.025_02.000
Variable Name
FQUITB_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the
following:
One-on-one counseling?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FQUITB_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.025_03.000
Variable Name
FQUITB_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKNOW(e)='3'
and ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or (SMKQTNO(e) LE '95' and
SMKQTTP(e)='2') or (SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or (SMKQTNO(e)
LE '02' and SMKQTTP(e)='4'))
Universe-text
Sample adults 18+ who are former smokers and quit in the last 2 years
Question Text
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the
following:
A stop smoking clinic, class or support group?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CIGEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.060_00.000
Variable Name
MENTHOL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2')
Universe-text
Sample adults 18+ who are current smokers
Question Text
Earlier you said you smoke cigarettes.
Is your usual cigarette brand menthol or non-menthol?
Answer Codes
1. Menthol
2. Non-menthol
3. No usual type
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions If CIGQTYR=1 store '1' in CSQEV
Skip Instructions
<1-3,R,D> if CIGQTYR=1 [store '1' in CSQEV] and [goto CQUITA_1];
else [goto CSQEV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.075_00.000
Variable Name
CSQEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e) IN ('1','2','7','8','9')
Universe-text
Sample adults 18+ who are current smokers
Question Text
Have you EVER stopped smoking for one day or longer BECAUSE YOU WERE
TRYING TO QUIT SMOKING?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto QWANT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.080_01.000
Variable Name
CQUITA_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following PRODUCTS:
A nicotine patch?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITA_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.080_02.000
Variable Name
CQUITA_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following PRODUCTS:
A nicotine gum or lozenge (LA-zenj)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITA_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.080_03.000
Variable Name
CQUITA_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following PRODUCTS:
A nicotine containing nasal spray or inhaler?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITA_4]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.080_04.000
Variable Name
CQUITA_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following PRODUCTS:
A prescription pill called Chantix (CHAN-tix) or Varenicline (vuh-REN-ih-klin)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITA_5]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.080_05.000
Variable Name
CQUITA_5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following PRODUCTS:
A prescription pill called Zyban (ZI-ban), Bupropion (byoo-PRO-pee-on), or Wellbutrin
(well-BYOO-trin)?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITB_1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.085_01.000
Variable Name
CQUITB_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following:
A telephone help line or quit line?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITB_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.085_02.000
Variable Name
CQUITB_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following:
One-on-one counseling?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CQUITB_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.085_03.000
Variable Name
CQUITB_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2') and CIGQTYR(e)='1'
Universe-text
Sample adults 18+ who are current smokers and tried to quit in the last year
Question Text
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you
use ANY of the following:
A stop smoking clinic, class or support group?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto QWANT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.100_00.000
Variable Name
QWANT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKEV(e)='1' and
SMKNOW(e) IN ('1','2')
Universe-text
Sample adults 18+ who are current smokers
Question Text
Would you like to completely quit smoking cigarettes?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ECIGEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.105_00.000
Variable Name
ECIGEV1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next question is about electronic cigarettes or e-cigarettes. You may also know
them as vape-pens, hookah-pens, e-hookahs, or e-vaporizers. Some look like
cigarettes, and others look like pens or small pipes. These are battery-powered,
usually contain liquid nicotine, and produce vapor instead of smoke.
Have you EVER used an e-cigarette EVEN ONE TIME?
*Read if necessary: E-cigarettes and similar products can be bought as one-time,
disposable products, as re-usable kits with a cartridge, or with refillable chambers.
These usually contain a liquid, often called an “e-liquid” or “e-juice.” Popular brands
include NJOY, BLU, LOGIC, and VUSE.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ECIGCUR1]
<2,R,D> [goto CIGAREV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 22 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.110_00.000
Variable Name
ECIGCUR1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ECIGEV1(e)='1'
Universe-text
Sample adults 18+ who have ever used e-cigarettes
Question Text
Do you now use e-cigarettes every day, some days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CIGAREV]
<2,3,R,D> [goto ECIG30D]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.115_00.000
Variable Name
ECIG30D
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ECIGCUR1(e) IN
('2','3',7','9')
Universe-text
Sample adults 18+ who now use e-cigarettes some days, not at all, or refused, or don't
know current e-cigarette status
Question Text
On how many of the PAST 30 DAYS have you used e-cigarettes?
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-30,R,D> [goto CIGAREV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 24 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.145_00.000
Variable Name
CIGAREV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever smoked a regular cigar, cigarillo, or a little filtered cigar EVEN ONE
TIME?
*Read if necessary: “Cigarillos” are medium cigars that sometimes are sold with plastic
or wooden tips. Some common brands are Black and Mild, Swisher Sweets, Dutch
Masters and Phillies Blunts. Cigarillos are usually sold individually or in packs of 5 or
fewer. Little filtered cigars look like cigarettes and are usually brown in color. Like
cigarettes, little filtered cigars have a spongy filter and are sold in packs of 20. Some
common brands are Prime Time and Winchester.
*Read if necessary: Do not include electronic cigars or e-cigars.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CIGEV501]
<2,R,D> [goto PIPEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.148_00.000
Variable Name
CIGEV501
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CIGAREV(e)='1'
Universe-text
Sample adults 18+ who have ever smoked a regular cigar, cigarillow, or filtered cigar
Question Text
Have you smoked at least 50 cigars, cigarillos, or little filtered cigars in your entire life?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CIGCUR1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 26 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.150_00.000
Variable Name
CIGCUR1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CIGAREV(e)='1'
Universe-text
Sample adults 18+ who have ever smoked a regular cigar, cigarillow, or filtered cigar
Question Text
Do you now smoke regular cigars, cigarillos, or little filtered cigars every day, some
days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PIPEV1]
<2,3,R,D> [goto CIG30D1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.151_00.000
Variable Name
CIG30D1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CIGCUR1 (e) IN
('2','3','7','9')
Universe-text
Sample adults 18+ who now smoke a regular cigar, cigarillo, or little filtered cigar some
days, not at all, or refused, or don’t know current cigar smoking status
Question Text
On how many of the PAST 30 DAYS have you smoked a regular cigar, cigarillo, or little
filtered cigar?
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-30,R,D> [goto PIPEV1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 28 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.152_00.000
Variable Name
PIPEV1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER smoked a pipe filled with tobacco-either a regular pipe, water pipe, or
hookah EVEN ONE TIME?
*Read if necessary: A hookah is a type of water pipe. It is sometimes called a “narghile”
(NAR-ge-lee) pipe. Do not include electronic hookah or e-hookahs.
*Read if necessary: Do not include electronic pipes or e-pipes.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PIPECUR1]
<2,R,D> [goto SMKLSTOB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.153_00.000
Variable Name
PIPECUR1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PIPEV1(e)='1'
Universe-text
Sample adults 18+ who have ever smoked a regular pipe, water pipe or hookah filled
with tobacco
Question Text
Do you now smoke pipes filled with tobacco – either regular pipes, water pipes, or
hookahs, every day, some days, or not at all?
*Read if necessary: Do not include pipes filled with substances other than tobacco.
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SMKLSTOB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.155_00.000
Variable Name
SMKLSTOB
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Smokeless tobacco products are placed in the mouth or nose and can include chewing
tobacco, snuff, dip, snus (SNOOSE), or dissolvable tobacco.
Have you ever used smokeless tobacco products EVEN ONE TIME?
*Read if necessary: Do not include nicotine replacement therapy products (such as
patch, gum, lozenge, or spray, which are considered smoking cessation treatments.)
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SMKLS20]
<2,R,D>
if (AAU.AMDLONG=1,2,R,D or AAI.ADENLONG=1,2,R,D) and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2) or (SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [goto MDTOB3];
else if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.157_00.000
Variable Name
SMKLS20
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKLSTOB(e)='1'
Universe-text
Sample adults 18+ who have ever used smokeless tobacco products
Question Text
Have you used smokeless tobacco products at least 20 times in your entire life?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SMKLSCUR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.159_00.000
Variable Name
SMKLSCUR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKLSTOB(e)='1'
Universe-text
Sample adults 18+ who have ever used smokeless tobacco products
Question Text
Do you NOW use smokeless tobacco products every day, some days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SMKLBRND]
<2,3,R,D> [goto SMKLS30D]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.161_00.000
Variable Name
SMKLS30D
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKLSCUR(e) IN
('2','3',''7','9')
Universe-text
Sample adults 18+ who use smokeless tobacco products some days, not at all, or
refused or don't know current smokeless using status
Question Text
On how many of the PAST 30 DAYS have you used chewing tobacco, snuff, dip, snus,
or dissolvable tobacco?
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0,R,D>
if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [goto MDTOB3];
else if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
<1-30> [goto SMKLBRND]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.163_00.000
Variable Name
SMKLBRND
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ('01' <=
SMKLS30D(e) <='30') or (SMLKSCUR = '1' )
Universe-text
Sample adults 18+ who use smokeless tobacco products at least once in the past 30
days.
Question Text
During the past 30 days, what brand of smokeless tobacco product did you use MOST
OFTEN?
*Do not read categories
Answer Codes
1. BEECH-NUT
2. CAMEL SNUS
3. COPE
4. COPENHAGEN
5. GENERAL SNUS
6. GRIZZLY
7. HUSKY
8. KAYAK
9. KODIAK
10. LEVI GARRETT
11. LONGHORN
12. MARLBORO SNUS
13. RED MAN
14. RED MAN GOLDEN BLEND
15. RED SEAL
16. SKOAL
17. SKOAL SNUS
18. SKOAL X-TRA
19. STOKER'S
20. TIMBER WOLF
21. Other (Specify)
Refused
Don't know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-20,R,D>
if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
Monday, August 25, 2014
Page 35 of 45
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [goto MDTOB3];
else if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
<21> [goto SMKLBRSP]
Hard Edits
Soft Edits
AssocHelp
Module
29
Section Name
Tobacco
Part
Question ID
NAE.165_00.000
Variable Name
SMKLBRSP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKLBRND(e)='21'
Universe-text
Sample adults 18+ who use other brand of smokeless tobacco most often
Question Text
*Specify the other brand of smokeless tobacco product used most often.
Answer Codes
Allow verbatim,R,D
Question Type
Verbatim
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [goto MDTOB3];
else if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.170_00.000
Variable Name
MDTOB3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AMDLONGR IN ('1','2','7','9') or ADNLONG2 IN ('1','2','7','9')) and
((CIGCUR1 IN ('1','2') or PIPECUR1 IN ('1','2') or ECIGCUR1 IN ('1','2')
or SMKLSCUR IN ('1','2')) or (SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4'))))))
Universe-text
Sample adults 18+ who have seen a doctor or other health professional in the past year
and are current cigarette smokers or former cigarette smokers who have quit in the
past 12 months, or who currently smoke cigars, or pipes, or use smokeless tobacco
every day or some days
Question Text
In the PAST 12 MONTHS, has a medical doctor, dentist, or other health professional
ADVISED you to quit smoking, or to quit using other kinds of tobacco?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HPTOB3]
<2,R,D> if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.171_00.000
Variable Name
HPTOB3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MDTOB3(e)='1'
Universe-text
Sample adults 18+ whose doctor or other health professional advised them to quit
smoking or using other kinds of tobacco in the past 12 months
Question Text
In the PAST 12 MONTHS, which of the following health professionals advised you to
quit smoking or quit using other kinds of tobacco?
*Read answer categories below.
*Enter all that apply, separate with commas.
Answer Codes
1. Medical doctor
2. Dentist
3. Nurse
4. Dental Hygienist
5. Other health professional
Refused
Don't know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D>
if SEX=2 and AGE=18-49 [goto LIVEBTH];
else [goto next section]
<5> [goto HPTOTH1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.172_00.000
Variable Name
HPTOTH1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HPTOB3(e)='5'
Universe-text
Sample adults 18+ who were advised to quit using tobacco by other health professional
Question Text
*Enter other health professional.
Answer Codes
Allow verbatim, R,D
Question Type
Verbatim
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
if SEX=2 and AGE=18-49[goto LIVEBTH];
else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.190_00.000
Variable Name
LIVEBTH
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2'
Universe-text
Female sample adults age 18-49
Question Text
Have you given birth to a live born infant within the past 5 years?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> if SMKEV=1 [goto SMKPREG];
else [goto next section]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.200_00.000
Variable Name
SMKPREG
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2' and SMKEV(e)='1' and
LIVEBTH(e)='1'
Universe-text
Female sample adults age 18-49 who have smoked at least 100 cigarettes in their
entire life and have had a live birth in the past 5 years
Question Text
Were you smoking cigarettes when you became pregnant with your last child?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SMKLST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 41 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.210_00.000
Variable Name
SMKLST
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2' and SMKEV(e)='1' and
LIVEBTH(e)='1'
Universe-text
Female sample adults age 18-49 who have smoked at least 100 cigarettes in their
entire life and have had a live birth in the past 5 years
Question Text
Did you smoke cigarettes at any time during your pregnancy with your last child?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto QUTWK]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.220_00.000
Variable Name
QUTWK
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2' and SMKLST(e)='1'
Universe-text
Female sample adults age 18-49 who have smoked at least 100 cigarettes in their
entire life and smoked during last pregnancy
Question Text
Did you quit smoking for 7 days or longer during your pregnancy with your last child?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto MTHQUIT]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.230_00.000
Variable Name
MTHQUIT
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2' and QUTWK(e)='1'
Universe-text
Female sample adults age 18-49 who have smoked at least 100 cigarettes in their
entire life and smoked during last pregnancy, but quit for 7 days or longer
Question Text
In what month of your pregnancy did you quit for 7 days or longer?
Answer Codes
1. First
2. Second
3. Third
4. Fourth
5. Fifth
6. Sixth
7. Seventh
8. Eighth
9. Ninth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-9,R,D> [goto STSMOK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 45
Module
29
Section Name
Tobacco
Part
Question ID
NAE.240_00.000
Variable Name
STSMOK
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX='2' and QUTWK(e)='1'
Universe-text
Female sample adults age 18-49 who have smoked at least 100 cigarettes in their
entire life and smoked during last pregnancy, but quit for 7 days or longer
Question Text
Did you start smoking again during the pregnancy or did you stay off cigarettes for the
rest of the pregnancy?
Answer Codes
1. Stayed off rest of pregnancy
2. Started again
3. Never started again
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 45 of 45
2015 Q1 NHIS Instrument Spec Report
Section name: Cancer Screening
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.010_00.000
Variable Name
SUN1HR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Now, we are going to ask you about your skin's reaction to the sun. After several
months of not being in the sun very much, if you went out in the sun for an hour without
sunscreen, a hat, or protective clothing, which one of these best describes what would
happen to your skin? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you
did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or
more.
Answer Codes
1. Get a severe sunburn with blisters
2. Have a moderate sunburn with peeling
3. Burn mildly with some or no darkening/tanning
4. Turn darker without sunburn
5. Nothing would happen to my skin
6. Do not go out in the sun
7. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "Even if you did not go out in the sun, what would happen if you did?
Use the most recent experience. If none, then think about the past." in BOLD GRAY
text.
Display the text "By "sunburn" we mean even a small part of your skin turns red or hurts
for 12 hours or more." In BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Monday, August 25, 2014
Page 1 of 170
Skip Instructions
<1-7,R,D> [goto SUNTAN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.015_00.000
Variable Name
SUNTAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Next, consider that you were out in the sun repeatedly, such as every day for two
weeks, without sunscreen, a hat, or protective clothing . Which one of these best
describes what your skin would LOOK like? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you
did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or
more.
Answer Codes
1. Very dark or deeply tanned
2. Dark/Moderately tanned
3. A little dark/Mildly tanned
4. Freckled but still light skinned
5. Burned repeatedly with little or no darkening or tanning---still light skinned
6. Don't go out in the sun
7. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text " Even if you did not go out in the sun, what would happen if you did?
Use the most recent experience. If none, then think about the past." in BOLD GRAY
text.
Display the text "By "sunburn" we mean even a small part of your skin turns red or hurts
for 12 hours or more." In BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-7,R,D> [goto SUN1_SHA]
Hard Edits
Soft Edits
Monday, August 25, 2014
Page 3 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.020_00.000
Variable Name
SUN1_SHA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Stay in the shade? Would you say (Read categories 1-5). . .
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-6,R,D> [goto SUN1_CAP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.022_00.000
Variable Name
SUN1_CAP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Wear a baseball cap or sun visor? Would you say (Read categories 1-5). . .
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "When you go outside on a warm sunny day for MORE than one hour,
how often do you..." in BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-6,R,D> [goto SUN_HAT1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.023_00.000
Variable Name
SUN_HAT1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) CAN4
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Wear a hat that shades your face, ears AND neck such as a hat with a wide brim all
around? Would you say (Read categories 1-5). . .
*Read if necessary: Do not include visors, baseball caps, or hats that do not shade the
face, ears and neck. Include legionnaire hats.
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "When you go outside on a warm sunny day for MORE than one hour,
how often do you..." in BOLD GRAY text.
Display the text " Do not include visors, baseball caps, or hats that do not shade The
face, ears and neck. Include legionnaire hats." In BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-6,R,D> [goto SUN2_LGS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.024_00.000
Variable Name
SUN2_LGS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Wear a long sleeved shirt? Would you say (Read categories 1-5). . .
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "When you go outside on a warm sunny day for MORE than one hour,
how often do you..." in BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-6,R,D> [goto SUN2_LGP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.025_00.000
Variable Name
SUN2_LGP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Wear long pants or other clothing that reaches your ankles? Would you say (Read
categories 1-5). . .
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "When you go outside on a warm sunny day for MORE than one hour,
how often do you..." in BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-6,R,D> [goto SUN2_SCR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.026_00.000
Variable Name
SUN2_SCR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you.
..
Use sunscreen? Would you say (Read categories 1-5). . .
Answer Codes
1. Always
2.Most of the time
3. Sometimes
4. Rarely
5. Never
6. Don't go out in the sun
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
Display the text "When you go outside on a warm sunny day for MORE than one hour,
how often do you..." in BOLD GRAY text.
Add a "visible" line after answer category #5 and before answer category #6 on this
screen. This would probably be similar to the separation on the AFLHCA screen
answer pane in the AHS section of Sample Adult.
Skip Instructions
<1-4> [goto SPF]
<5,6,R,D> [goto NBURN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.027_00.000
Variable Name
SPF
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SUN2_SCR(e) IN
('1','2','3','4')
Universe-text
Sample adults 18+ who use sunscreen at least rarely
Question Text
? [F1]
What is the SPF number of the sunscreen you use MOST often?
*Read if necessary: If you use more than one or different ones, pick the one used most
often.
*Enter '96' if unable to pick the one used most often.
*Enter '50' if 50 or higher SPF.
Answer Codes
Allow 1-50,96, R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Display the text "If you use more than one or different ones, pick the one used most
often." in BOLD GRAY text.
Skip Instructions
<1-50> [goto NBURN]
<96,R,D> [goto SPFSCALE]
<51-95> [goto ERR_SPF]
Hard Edits
ERR_SPF
*51-95 not allowed in this field.
*Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.028_00.000
Variable Name
SPFSCALE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SPF(e) IN
('96','97','99')
Universe-text
Sample adults 18+ who answered more than one, different ones, or other to SPF
number, or did not know or refused to say the SPF
Question Text
Is the SPF usually 1-14 or 15-50?
*Enter '2' if 50 or higher SPF.
Answer Codes
1. 1-14
2. 15-50
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto NBURN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.030_00.000
Variable Name
NBURN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, how many times have you had a sunburn?
*Read if necessary: By "sunburn" we mean even a small part of your skin turns red or
hurts for 12 hours or more. Also include burns from sunlamps and other indoor tanning
devices.
*Enter '0' for none.
Answer Codes
Allow 0-365,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Display the text "By "sunburn" we mean even a small part of your skin turns red or hurts
for 12 hours or more. Also include burns from sunlamps and other indoor tanning
devices." in BOLD GRAY text.
Skip Instructions
<0-365,R,D> [goto SNEVER]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.031_00.000
Variable Name
SNEVER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER used an indoor tanning device such as a sunlamp, sunbed, or tanning
booth? Do NOT include times you have gotten a spray-on tan.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SNONCE]
<2,R,D> [goto STP12M ]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.032_00.000
Variable Name
SNONCE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SNEVER(e)='1'
Universe-text
Sample adults 18+ who have ever used an indoor tanning device
Question Text
DURING THE PAST 12 MONTHS, have you used an indoor tanning device such as a
sunlamp, sunbed, or tanning booth EVEN ONE TIME? Do NOT include times you
have gotten a spray-on tan.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SNNUM1]
<2,R,D> [goto STP12M]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.033_00.000
Variable Name
SNNUM1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SNONCE(e)='1'
Universe-text
Sample adults 18+ who have used indoor tanning device in the past year
Question Text
DURING THE PAST 12 MONTHS, how many times have you used an indoor tanning
device such as a sunlamp, sunbed or tanning booth? Do NOT include times you have
gotten a spray-on tan.
Answer Codes
Allow 1-365,
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-365,R,D> [goto SNPROB]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.035_00.000
Variable Name
SNPROB
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SNONCE(e)='1'
Universe-text
Sample adults 18+ who have used indoor tanning device in the past year
Question Text
DURING THE PAST 12 MONTHS, have you had a problem such as a burn, rash, or
skin infection caused by using an indoor tanning device such as a sunlamp, sunbed, or
tanning booth?
*Read if necessary: Do NOT include problems you have experienced from getting a
spray-on tan.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SNPRTYP]
<2,R,D> [goto STP12M]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.037_00.000
Variable Name
SNPRTYP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (SNONCE(e)='1')
and (SNPROB(e)='1')
Universe-text
Sample adults 18+ who have had a problem using an indoor tanning device in past year
Question Text
Which of the following problem or problems did you have?
*Read categories below.
*Read if necessary: By “sunburn” we mean even a small part of your skin turns red or
hurts for 12 hours or more.
* Enter all that apply, separate with commas.
Answer Codes
1. Got a sunburn
2. Got a rash
3. Got a skin infection
4. Experienced another problem
Refused
Don't know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto STP12M]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.038_00.000
Variable Name
STP12M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you used self-applied sunless tanning
products, also known as self-tanning or fake tanning?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SPR12M]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.039_00.000
Variable Name
SPR12M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you gotten a spray-on or mist tan AT A
TANNING SALON or other business?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SKNX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.040_00.000
Variable Name
SKNX
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now we are going to ask you about medical tests and exams that check for cancer.
Have you EVER had all of your skin from head to toe checked for cancer either by a
dermatologist or some other kind of doctor?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto RSKX1_MT]
<2,R,D> if SEX=2 [goto MENSTAGE];
else if SEX=1 and AGE le 64 [goto HPVHRD]
else if SEX=1 and AGE ge 65 [goto CHESTX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.050_01.000
Variable Name
RSKX1_MT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1'
Universe-text
Sample adults 18+ who have had a skin exam
Question Text
1 of 2
When did you have your MOST RECENT skin exam to check for cancer?
*Enter month of last skin exam.
* Enter '96' to go to the number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions if RSKX1_MT = store 'R' in RSKX1_YR
if RSKX1_MT = <96> store '9996' in RSKX1_YR
Skip Instructions
<1-12,D> [goto RSKX1_YR]
store "R' in RSKX1_YR [goto RSKX2]
<96> store "9996" in RSKX1_YR [goto RSKX1N]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.050_02.000
Variable Name
RSKX1_YR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1' and
('01' <= RSKX1_MT <= '12' or RSKX1_MT='99')
Universe-text
Sample adults age 18+ who answered month of last skin exam or didn't know month of
last skin exam
Question Text
2 of 2
*Enter year of last skin exam.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RSKX1_YR gt current year or (RSKX1_YR=current year and RSKX1_MT gt current
month)
goto ERR1_ RSKX1_YR (future date)
elseif RSKX1_YR lt DOBY or (RSKX1_YR=DOBY and RSKX1_MT lt DOBM)
goto ERR2_ RSKX1_YR (prior to birth date)
elseif RSKX1_MT=D and RSKX1_YR < current year-5
set RSKX2=5
goto SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year-4
set RSKX2=4
goto SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year
set RSKX2=1
goto SKINREAS
elseif RSKX1_MT=D and (RSKX1_YR = current year-1 or RSKX1_YR = current year-2
or RSKX1_YR = current year-3 or RSKX1_YR = current year-5)
goto RSKX2
elseif RSKX1_MT=1-12
goto SKINREAS
goto RSKX2
Hard Edits
ERR1_ RSKX1_YR
* Future date invalid. Please correct.
ERR2_ RSKX1_YR
* Date before birth. Please correct.
Soft Edits
Monday, August 25, 2014
Page 22 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.055_01.000
Variable Name
RSKX1N
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1' and
RSKX1_MT(e)='96'
Universe-text
Sample adults 18+ who selected number and time period format for most recent skin
exam
Question Text
1 of 2
When did you have your MOST RECENT skin exam?
*Enter number for time since last skin exam.
*Enter '95' for 95 or more.
Answer Codes
All 1-95,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RSKX1N = store 'R' in RSKX1T
if RSKX1N = store 'D' in RSKX1T
Skip Instructions
<1-95> [goto RSKX1T]
store "R,D" in RSKX1T [goto RSKX2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.055_02.000
Variable Name
RSKX1T
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1' and
RSKX1_MT(e)='96' and ('01' <= RSKX1N <= '95')
Universe-text
Sample adults 18+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent skin exam.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions If RSKX1N gt 5 and RSKX1T=4, store '5' in RSKX2.
If RSKX1N=4 and RSKX1T=4, store '4' in RSKX2.
Skip Instructions
<1-3> goto SKINREAS
<4> if RSKX1N=4, set RSKX2=4, [goto SKINREAS]
elseif RSKX1N gt 5 and RSKX1N gt AGE, [goto ERR_RSKX1T (greater than
persons age)]
elseif RSKX1N gt 5 and RSKX1N le AGE, set RSKX2=5, [goto SKINREA]
elseif RSKX1N=1,2,3,5, goto RSKX2
goto RSKX2
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 24 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.060_00.000
Variable Name
RSKX2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1' and
(RSKX1_MT(e) IN ('97','98','99') or RSKX1_YR(e) IN ('9997','9998','9999') or
RSKX1N(e) IN ('97','98','99') or RSKX1T(e) IN ('7','8','9') or (RSKX1T(e) = '4' and
RSKX1N IN ('1','2','3','5')))
Universe-text
Sample adults 18+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last skin exam was over 5 years
ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RSKX1N gt 5 and RSKX1T=4, store '5' in RSKX2 and don't ask question.
If RSKX1N=4 and RSKX1T=4, store '4' in RSKX2 and don't ask question.
Based upon prior answers:
if RSKX1N = 1 and RSKX1T = '4', gray out answer codes 3,4,5
if RSKX1N = 2 and RSKX1T = '4', gray out answer codes 1,4,5
if RSKX1N = 3 and RSKX1T = '4', gray out answer codes 1,2,5
if RSKX1N = 5 and RSKX1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D>
if answer code is grayed out [goto ERR_RSKX2]
else [goto SKINREAS]
Hard Edits
ERR_RSKX2
*That is not a valid response.
*Please correct.
Soft Edits
Monday, August 25, 2014
Page 25 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.070_00.000
Variable Name
SKINREAS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SKNX(e)='1'
Universe-text
Sample adults 18+ who have had a skin exam
Question Text
What was the MAIN reason you had this skin exam -- was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D>
if SEX=2 [goto MENSTAGE]
else if SEX=1 and AGE le 64 [goto HPVHRD]
else if SEX=1 and AGE ge 65 [goto CHESTX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 26 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.080_00.000
Variable Name
MENSTAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+
Question Text
The following questions are about women's health. How old were you when your
periods or menstrual cycles started?
*Enter '0' for haven't started.
Answer Codes
Allow 0, 6-60,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if nae.LIVEBTH (NAE.190_00.000) = '1' (in Tobacco section) store '1' in BIRTHEV
(NAF.110_00.000)
Skip Instructions
<6-60,R,D>
if MENSTAGE gt AGE [goto ERR1_MENSTAGE]
elseif AGE ge 39 [goto MENSTILL]
else if AGE le 38 and nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif AGE le 38 and nae.LIVEBTH = '1' [goto BIRTHNUM]
<0> if nae.LIVEBTH ne '1' goto BIRTHEV
else goto BIRTHNUM
<1-5> [goto ERR2_MENSTAGE]
Hard Edits
ERR1_MENSTAGE
* Entry cannot be greater than age.
* Please correct.
ERR2_MENSTAGE
* Not a valid code.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.090_00.000
Variable Name
MENSTILL
Universe
HHSTAT4='S' and (AGE GE '039' and AGE not IN ('997','999')) and SEX='2' and
MENSTAGE ne '00'
Universe-text
Female sample adults 39+ who have started menstrual cycles
Question Text
Do you still have periods or menstrual cycles?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions if nae.LIVEBTH (NAE.190_00.000) = '1' (in Tobacco section) store '1' in BIRTHEV
(NAF.110_00.000)
Skip Instructions
<1,R,D> if nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]
<2> [goto MENLAST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 28 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.100_00.000
Variable Name
MENLAST
Universe
HHSTAT4='S' and (AGE GE '039' and AGE not IN ('997','999')) and SEX='2' and
MENSTILL='2'
Universe-text
Female sample adults 39+ who do not have periods any more
Question Text
When did you have your last period or menstrual cycle? Was it…
* Read categories below.
Answer Codes
1. 1 year ago or less
2. More than 1 year ago but less than 2 years ago
3. 2 years ago or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions if nae.LIVEBTH (NAE.190_00.000) = '1' (in Tobacco section) store '1' in BIRTHEV
(NAF.110_00.000)
Display answer categories 1-3 in BOLD BLACK text.
Skip Instructions
<1-3,R,D>
if nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.110_00.000
Variable Name
BIRTHEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+ who did not already answer they had a live birth
Question Text
*If you remember that the respondent mentioned having a biological child in the core,
verify the information and enter '1' for yes (and don't ask question).
Have you EVER given birth to a live born infant?
*Read if necessary.
A live born infant is an infant born alive.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions nae.LIVEBTH (NAE.190_00.000) is in the Tobacco (NAE) Cancer Supplement section.
Display the text " A live born infant is an infant born alive." in BOLD GRAY text.
Skip Instructions
<1> [goto BIRTHNUM]
<2,R,D> [goto PAPHAD1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.111_00.000
Variable Name
BIRTHNUM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
BIRTHEV(e)='1'
Universe-text
Female sample adults 18+ who have ever had a live born infant
Question Text
What is the total number of live births (live born children) you have had?
*Enter '25' for 25 or more.
Answer Codes
Allow 1-25,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-25,R,D> [goto BIRTHAGE]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 31 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.120_00.000
Variable Name
BIRTHAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
BIRTHEV(e)='1'
Universe-text
Female sample adults 18+ who have ever had a live born infant
Question Text
How old were you when your [fill1: child/first child] was born?
Answer Codes
Allow 6-60,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
[fill 1] if BIRTHNUM = '1' fill 'child' else fill 'first child'
Special Instructions
Skip Instructions
<6-60,R>
if BIRTHAGE GT AGE [goto ERR_BIRTHAGE]
else [goto PAPHAD1]
[goto BIRTHAG2]
Hard Edits
ERR_BIRTHAGE
* Entry cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.121_00.000
Variable Name
BIRTHAG2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
BIRTHEV(e)='1' and BIRTHAGE(e)='99'
Universe-text
Female sample adults 18+ who didn't know their age at first's child's birth
Question Text
What year was your [fill1: child/first child] born?
Answer Codes
Allow 1880-2016,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
[fill 1] if BIRTHNUM = '1' fill 'child' else fill 'first child'
Special Instructions
Skip Instructions
<1880-2016,R,D>
if BIRTHAG2 gt current year [goto ERR1_BIRTHAG2]
elseif BIRTHAG2 gt year of birth (DOBY) [goto ERR2_BIRTHAG2]
else [goto PAPHAD1]
Hard Edits
ERR1_BIRTHAG2
* Entry must be current year or earlier.
* Please correct.
ERR2_BIRTHAG2
* Entry cannot be earlier than sample adult's year of birth.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 33 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.130_00.000
Variable Name
PAPHAD1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+
Question Text
Have you EVER HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the
cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to
the lab.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "A Pap smear or Pap test is a routine test for women in which the
doctor examines the cervix, takes a cell sample from the cervix with a small stick or
brush, and sends it to the lab." in BOLD GRAY text.
Skip Instructions
<1>
if AGE 18-30 [goto PAPFRST1]
else [goto PAP6YR1]
<2> if AGE LE 64 [goto HPVHRD]; else [goto PAPNOT2]
if AGE le 64 [goto HPVHRD];
else [goto HYST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.135_00.000
Variable Name
PAPFRST1
Universe
HHSTAT4='S' and (AGE LE '030' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1'
Universe-text
Female sample adults 18-30 who have ever had a Pap test
Question Text
At what age did you have your first Pap test?
Answer Codes
Allow 6-30,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<6-30,R,D> if PAPFRST1 gt AGE(HHSTAT4='S') [goto ERR_PAPFRST1]
else [goto PAP6YR1]
Hard Edits
ERR_PAPFRST1
* Age at first Pap test cannon be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 35 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.140_00.000
Variable Name
PAP6YR1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1'
Universe-text
Female sample adults 18+ who have ever had a Pap test
Question Text
How many Pap tests have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.
Answer Codes
Allow 0-95,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-95,R,D> [goto RPAP1_M1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_01.000
Variable Name
RPAP1_M1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1'
Universe-text
Female sample adults 18+ who have ever had a Pap test
Question Text
1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions if RPAP1_M1 = store 'R' in RPAP1_Y1
if RPAP1_M1 = <96> store '9996' in RPAP1_Y1
Skip Instructions
<1-12,D> [goto RPAP1_Y1]
store "R' in RPAP1_Y1 [goto RPAP21]
<96> store "9996" in RPAP1_Y1 [goto RPAP1N1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 37 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_02.000
Variable Name
RPAP1_Y1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ('01' <= RPAP1_M1 <= '12' or RPAP1_M1='99')
Universe-text
Female sample adults age 18+ who answered month of last Pap test test or didn't know
month of last Pap test test
Question Text
2 of 2
*Enter year of last Pap test.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPAP1_Y1 gt current year or (RPAP1_Y1=current year and RPAP1_M1
gt current month)
[goto ERR1_ RPAP1_Y1 (future date)]
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM)
[goto ERR2_ RPAP1_Y1 (prior to birth date)]
elseif RPAP1_M1=D
[goto RPAP21]
elseif RPAP1_M1=1-12 and AGE LT 65 [goto HPVHRD];
else [goto PAPREA2]
[goto RPAP21]
Hard Edits
ERR1_ RPAP1_Y1
* Future date invalid. Please correct.
ERR2_ RPAP1_Y1
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_01.000
Variable Name
RPAP1N1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96'
Universe-text
Female sample adults 18+ who selected number and time period format for most
recent Pap test test from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RPAP1N1 = store 'R' in RPAP1T1
if RPAP1N1 = store 'D' in RPAP1T1
Skip Instructions
<1-95> [goto RPAP1T1]
store "R,D" in RPAP1T1 [goto RPAP21]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 39 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_02.000
Variable Name
RPAP1T1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96' and ('01' <= RPAP1N1 <= '95')
Universe-text
Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent Pap test.
Answer Codes
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21.
Skip Instructions
<1-3> if AGE LT 65 [goto HPVHRD];
else [goto PAPREA2]
<4> if RPAP1N1=4, set RPAP21=4
if AGE LT 65 [goto HPVHRD];
else [goto PAPREA2]
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE, [goto ERR_RPAP1T1 (greater than
persons age)]
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE, set RPAP21=5
if AGE LT 65 [goto HPVHRD]; else [goto PAPREA2]
elseif RPAP1N1=1,2,3,5, [goto RPAP21]
[goto RPAP21]
Hard Edits
ERR_RPAP1T1
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.165_00.000
Variable Name
RPAP21
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and (RPAP1_M1(e) IN ('97','98','99') or RPAP1_Y1(e) IN
('9997','9998','9999') or RPAP1N1(e) IN ('97','98','99') or RPAP1T1(e) IN ('7','8','9') or
(RPAP1T1(e) = '4' and RPAP1N1 IN ('1','2','3','5')))
Universe-text
Female sample adults 18+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last Pap test test
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21 and don't ask question.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21 and don't ask question.
Based upon prior answers:
if RPAP1N1 = 1 and RPAP1T1 = '4', gray out answer codes 3,4,5
if RPAP1N1 = 2 and RPAP1T1 = '4', gray out answer codes 1,4,5
if RPAP1N1 = 3 and RPAP1T1 = '4', gray out answer codes 1,2,5
if RPAP1N1 = 5 and RPAP1T1 = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPAP21]
else if AGE LT 65 [goto HPVHRD];
else [goto PAPREA2]
Hard Edits
ERR_RPAP21
*That is not a valid response.
*Please correct.
Soft Edits
Monday, August 25, 2014
Page 41 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.167_00.000
Variable Name
HPVHRD
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999'))
Universe-text
Sample adults LE 64
Question Text
Have you ever heard of HPV? HPV stands for human papillomavirus (pap-uh-LOWmuh-vi-rus).
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> If SEX=1 and AGE GE 40 [goto CHESTX];
else if SEX=1 and AGE LT 40 [goto ASPIRIN];
else if SEX=2 and PAPHAD1=2 [goto PAPNOT2]; else [goto HPVPAP]
Hard Edits
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Monday, August 25, 2014
Page 42 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.168_00.000
Variable Name
HPVPAP
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and PAPHAD1(e)='1'
Universe-text
Female sample adult who have ever had a Pap test
Question Text
An HPV test is sometimes given with the Pap test for cervical cancer screening. Did
you have an HPV test with your most recent Pap?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PAPREA2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 43 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.170_00.000
Variable Name
PAPREA2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
(PAPHAD1(e)='1') or (HPVPAP(e)='1')
Universe-text
Female sample adults 18+ who have ever had a Pap or HPV test
Question Text
What was the MAIN reason you had this [fill1: Pap/Pap or HPV] test - was it part of a
routine exam, because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Fill1: if HPVPAP=1 fill "Pap or HPV"; else fill "Pap"
Special Instructions
Skip Instructions
<1-3,R,D>
if (RPAP21 = 1,2,3) or (RPAP1T1 = 1,2) or (RPAP1_Y1 = (current year – 3) and
RPAP1_M1 ge current month) or (RPAP1_Y1 gt (current year – 3)) or (RPAP1T1 = 3
and RPAP1N1 le 36) [goto PAPABN3]
elseif (RPAP21 = 5) or (RPAP1_Y1 = (current year – 5) and RPAP1_M1 lt current
month) or (RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = 3 and RPAP1N1 gt 60)
[goto PAPNOT2]
elseif RPAP21 = R,D [goto MDRECP1]
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Monday, August 25, 2014
Page 44 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.180_00.000
Variable Name
PAPABN3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ((RPAP21 IN (‘1’,’2’,’3’) or (RPAP1T1 IN (‘1’,’2’) or (RPAP1_Y1 =
(current year – 3) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt (current year –
3) and RPAP1_Y1 not IN ('9996','9997','9999')) or (RPAP1T1 = '3' and RPAP1N1 le
'36') or (RPAP1T1 = '4' and RPAP1N1 IN ('1','2','3') and RPAP21 IN ('7','9')))
Universe-text
Female sample adults 18+ who have had a Pap test in the past 3 years
Question Text
Have you had a [fill1: Pap/Pap or HPV] test in the LAST 3 YEARS where the results
were NOT normal?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: if HPVPAP=1 fill "Pap or HPV"; else fill "Pap"
Special Instructions
Skip Instructions
<1,2,R,D> [goto MDRECP1]
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AssocHelp
Monday, August 25, 2014
Page 45 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.210_00.000
Variable Name
PAPNOT2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
((PAPHAD1 = '2') or (RPAP21 IN ('5')) or (RPAP1_Y1 = (current year – 5) and
RPAP1_M1 lt current month) or (RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = '3'
and RPAP1N1 gt '60') or (RPAP1T1 = '4' and RPAP1N1 gt '5' and RPAP21 IN ('7','9')))
Universe-text
Female sample adults 18+ who have never had a Pap test, or who have not had a Pap
test in the last 5 years
Question Text
What is the most important reason you have
[Fill1: NEVER had a Pap test/NEVER had a Pap or HPV test/
NOT had a Pap test in the LAST 5 YEARS/
NOT had a Pap or HPV test in the LAST 5 YEARS]?
*Put response into correct category below.
Answer Codes
1. No reason/never thought about it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put it off/didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant, or embarrassing
8. Had hysterectomy
9. Don't have doctor
10. Had HPV vaccine
11. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
[fill 1] if PAPHAD1 = '2' and HPVPAP ne 1, fill 'NEVER had a Pap test';
else if PAPHAD1=1 and HPVPAP=1 fill "NEVER had a Pap or HPV test";
else fill "NOT had a Pap test in the LAST 5 YEARS" if HPVPAP is ne '1';
else fill "NOT had a Pap or HPV test in the LAST 5 YEARS"
Special Instructions if PAPNOT2 = <8> store '1' in HYST and do not ask HYST question
Skip Instructions
<1,2,4-7,10-11,R,D> [goto MDRECP1]
<3,8,9> [goto PAPHPVPY]
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Monday, August 25, 2014
Page 46 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.215_00.000
Variable Name
MDRECP1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPNOT2(e) not IN ('03','08','09') and PAPHAD1(e) not IN ('7','9')
Universe-text
Female sample adults 18+ who had a doctor, who didn't answer that her doctor didn't
recommend a Pap test, who haven't had a hysterectomy, and gave a reason for not
having Pap test ever/in the last 5 years
Question Text
[fill1: Was your most recent Pap test recommended by a doctor or other health
professional?/Was your most recent Pap or HPV test recommended by a doctor or
other health professional?"
[fill2: In the PAST 12 MONTHS, has a doctor or other health professional
RECOMMENDED that you have a PAP test?/In the PAST 12 MONTHS, has a doctor
or other health professional RECOMMENDED that you have a PAP or HPV test?]
Answer Codes
1. Yes
2. No
3. Did not see a doctor in the last 12 months
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: if PAPHAD1 = '1' and ((RPAP21 = 5) or (RPAP1T1 = 1,2) or (RPAP1_Y1 =
(current year – 5) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt (current year –
5)) or (RPAP1T1 = 3 and RPAP1N1 le 60)) and HPVPAP ne ‘1’ fill: "Was your most
recent Pap test recommended by a doctor or other health professional?" ;
else if HPVPAP = ‘1’ fill "Was your most recent Pap or HPV test recommended by a
doctor or other health professional?"
Fill2: if PAPHAD1=2, or PAPHAD1=1 and GT 5 years from system date or
RPAP21=R,D and HPVPAP ne ‘1’ fill "In the PAST 12 MONTHS, has a doctor or other
health professional RECOMMENDED that you have a PAP test?"; else if HPVPAP=‘1’
fill " In the PAST 12 MONTHS, has a doctor or other health professional
RECOMMENDED that you have a PAP or HPV test?"
Special Instructions
Skip Instructions
<1,2,3,R,D> [goto PAPHPVPY]
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AssocHelp
Monday, August 25, 2014
Page 47 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.217_00.000
Variable Name
PAPHPVPY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
(PAPHAD(e)='1') or (HPVPAP(e)='1')
Universe-text
Female sample adults 18+ who have ever had a Pap or HPV test
Question Text
How much did you pay out of pocket for this [fill1: Pap/Pap or HPV] test-Was it NONE,
PART, or ALL of the cost?
Answer Codes
1. None of the cost
2. Part of the cost
3. All of the cost
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Fill1: if HPVPAP=1 fill "Pap or HPV"; else fill "Pap"
Special Instructions
Skip Instructions
<1-3,R,D> if PAPNOT2=8 [goto RHYS1_MT];
else [goto HYST]
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Monday, August 25, 2014
Page 48 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.220_00.000
Variable Name
HYST
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPNOT2(e) ne '08'
Universe-text
Female sample adults 18+ who have not already indicated they have had a
hysterectomy
Question Text
Have you had a hysterectomy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto RHYS1_MT]
<2,R,D> [goto OVARIES]
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Monday, August 25, 2014
Page 49 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.221_01.000
Variable Name
RHYS1_MT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
HYST(e)='1'
Universe-text
Female sample adults 18+ who have ever had a hysterectomy
Question Text
1 of 2
When was your hysterectomy?
*Enter month of hysterectomy.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions if RHYS1_MT = store 'R' in RHYS1_YR
If RHYS1_MT = <96> store '9996' in RHYS1_YR
Skip Instructions
<1-12,D> [goto RHYS1_YR]
store "R' in RHYS1_YR [goto RHYS2]
<96> store "9996" in RHYS1_YR [goto RHYS1N]
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Monday, August 25, 2014
Page 50 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.221_02.000
Variable Name
RHYS1_YR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
HYST(e)='1' and ('01' <= RHYS1_MT <= '12' or RHYS1_MT='99')
Universe-text
Female sample adults age 18+ who answered month of hysterectomy or didn't know
month of hysterectomy
Question Text
2 of 2
*Enter year of hysterectomy.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RHYS1_YR gt current year or (RHYS1_YR=current year and
RHYS1_MT gt current month)
goto ERR1_ RHYS1_YR (future date)
elseif RHYS1_YR lt DOBY or (RHYS1_YR=DOBY and RHYS1_MT lt DOBM)
goto ERR2_ RHYS1_YR (prior to birth date)
elseif RHYS1_MT=D
goto RHYS2
elseif RHYS1_MT=1-12
goto OVARIES
goto RHYS2
Hard Edits
ERR1_ RHYS1_YR
* Future date invalid. Please correct.
ERR2_ RHYS1_YR
* Date before birth. Please correct
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.222_01.000
Variable Name
RHYS1N
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
HYST(e)='1' and RHYS1_MT(e)='96'
Universe-text
Female sample adults 18+ who selected number and time period format for
hysterectomy from the initial month screen
Question Text
1 of 2
When was your hysterectomy?
*Enter number for time since hysterectomy.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RHYS1N = store 'R' in RHYS1T
if RHYS1N = store 'D' in RHYS1
Skip Instructions
<1-95> [goto RHYS1T]
store "R,D" in RHYS1T [goto RHYS2]
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Monday, August 25, 2014
Page 52 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.222_02.000
Variable Name
RHYS1T
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
HYST='1' and RHYS1_MT(e)='96' and ('01' <= RHYS1N <= '95')
Universe-text
Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since hysterectomy.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions If RHYS1N gt 5 and RHYS1T=4, store '5' in RHYS2 and don't ask question.
If RHYS1N=4 and RHYS1T=4, store '4' in RHYS2 and don't ask question
Skip Instructions
<1-3> [goto OVARIES]
<4> if RHYS1N=4
set RHYS2=4
[goto OVARIES]
elseif RHYS1N gt 5 and RHYS1N gt AGE
[goto ERR_RHYS1T (greater than persons age)]
elseif RHYS1N gt 5 and RHYS1N le AGE
set RHYS2=5
[goto OVARIES]
elseif RHYS1N=1,2,3,5
[goto RHYS2]
[goto RHYS2]
Hard Edits
ERR_RHYS1T
* Time since last exam cannot be greater than age.
* Please correct
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 53 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.225_00.000
Variable Name
RHYS2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
HYST(e)='1' and (RHYS1_MT(e) IN ('97','98','99') or RHYS1_YR(e) IN
('9997','9998','9999') or RHYS1N(e) IN ('97','98','99') or RHYS1T(e) IN ('7','8','9') or
(RHYS1T(e) = '4' and RHYS1N IN ('1','2','3','5')))
Universe-text
Female sample adults 18+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose hysterectomy was
over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RHYS1N gt 5 and RHYS1T=4, store '5' in RHYS2 and don't ask question.
If RHYS1N=4 and RHYS1T=4, store '4' in RHYS2 and don't ask question.
Based upon prior answers:
if RHYS1N = 1 and RHYS1T = '4', gray out answer codes 3,4,5
if RHYS1N = 2 and RHYS1T = '4', gray out answer codes 1,4,5
if RHYS1N = 3 and RHYS1T = '4', gray out answer codes 1,2,5
if RHYS1N = 5 and RHYS1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RHYS2]
else [goto OVARIES]
Hard Edits
ERR_RHYS2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.226_00.000
Variable Name
OVARIES
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults age 18+
Question Text
Have you EVER had BOTH ovaries removed, either as part of a hysterectomy or as
one or more separate surgeries?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto OVARAGE]
<2,R,D> if age GE 30 [goto CBEHAD];
else [goto ASPIRIN]
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Monday, August 25, 2014
Page 55 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.227_00.000
Variable Name
OVARAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
OVARIES='1'
Universe-text
Female sample adults age 18+ who have had BOTH ovaries removed
Question Text
How old were you when you had BOTH of your ovaries removed?
Answer Codes
Allow 1-120,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-120,R,D> if OVARAGE GT AGE [goto ERR_OVARAGE]
elseif age GE 30 [goto CBEHAD];
elseIF age lt 30 [goto ASPIRIN]
Hard Edits
ERR_OVARAGE
* Entry is greater than sample adult's age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.228_00.000
Variable Name
CBEHAD
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 30+
Question Text
Have you EVER HAD a breast exam done by a doctor or other health professional to
check for lumps or other signs of breast cancer?
*Read if necessary. A breast exam is when the breasts are felt by a doctor or other
health professional to check for lumps or other signs of breast cancer.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto RCBE1_MT]
<2,R,D> [goto MAMHAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 57 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.229_01.000
Variable Name
RCBE1_MT
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
CBEHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a breast exam
Question Text
1 of 2
When did you have your MOST RECENT breast exam?
*Enter month of last breast exam.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions if RCBE1_MT = store 'R' in RCBE1_YR
If RCBE1_MT = <96> store '9996' in RCBE1_YR
Skip Instructions
<1-12,D> [goto RCBE1_YR]
store "R' in RCBE1_YR [goto RCBE2]
<96> store "9996" in RCBE1_YR [goto RCBE1N]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.229_02.000
Variable Name
RCBE1_YR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
CBEHAD(e)='1' and ('01' <= RCBE1_MT <= '12' or RCBE1_MT='99')
Universe-text
Female sample adults age 30+ who answered month of breast exam didn't know
month of breast exam
Question Text
2 of 2
*Enter year of most recent breast exam.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RCBE1_YR gt current year or (RCBE1_YR=current year and
RCBE1_MT gt current month)
goto ERR1_ RCBE1_YR (future date)
elseif RCBE1_YR lt DOBY or (RCBE1_YR=DOBY and RCBE1_MT lt DOBM)
goto ERR2_ RCBE1_YR (prior to birth date)
elseif RCBE1_MT=D
goto RCBE2
elseif RCBE1_MT=1-12
[goto MAMHAD]
[goto RCBE2]
Hard Edits
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Monday, August 25, 2014
Page 59 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.229_03.000
Variable Name
RCBE1N
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
CBEHAD(e)='1' and RCBE1_MT(e)='96'
Universe-text
Female sample adults 30+ who selected number and time period format for breast
exam from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95,R,D
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RCBE1N = store 'R' in RCBE1T
if RCBE1N = store 'D' in RCBE1
Skip Instructions
<1-95> [goto RCBE1T]
store "R,D" in RCBE1T [goto RCBE2]
Hard Edits
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AssocHelp
Monday, August 25, 2014
Page 60 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.229_04.000
Variable Name
RCBE1T
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
CBEHAD(e)='1' and RCBE1_MT(e)='96' and ('01' <= RCBE1N <= '95')
Universe-text
Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent breast exam.
Answer Codes
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions If RCBE1N gt 5 and RCBE1T=4, store '5' in RCBE2 and don't ask question.
If RCBE1N=4 and RCBE1T=4, store '4' in RCBE2 and don't ask question
Skip Instructions
<1-3> [goto MAMHAD]
<4> if RCBE1N=4
set RCBE2=4
[goto MAMHAD]
elseif RCBE1N gt 5 and RCBE1N gt AGE
[goto ERR_RCBE1T (greater than persons age)]
elseif RCBE1N gt 5 and RCBE1N le AGE
set RCBE2=5
[goto MAMHAD]
elseif RCBE1N=1,2,3,5
[goto RCBE2]
goto RCBE2
Hard Edits
ERR_RCBE1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 61 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.229_05.000
Variable Name
RCBE2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
CBEHAD(e)='1' and (RCBE1_MT(e) IN ('97','98','99') or RCBE1_YR(e) IN
('9997','9998','9999') or RCBE1N(e) IN ('97','98','99') or RCBE1T(e) IN ('7','8','9') or
(RCBE1T(e) = '4' and RCBE1N IN ('1','2','3','5')))
Universe-text
Female sample adults 30+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose breast exam was
over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RCBE1N gt 5 and RCBE1T=4, store '5' in RCBE2 and don't ask question.
If RCBE1N=4 and RCBE1T=4, store '4' in RCBE2 and don't ask question.
Based upon prior answers:
if RCBE1N = 1 and RCBE1T = '4', gray out answer codes 3,4,5
if RCBE1N = 2 and RCBE1T = '4', gray out answer codes 1,4,5
if RCBE1N = 3 and RCBE1T = '4', gray out answer codes 1,2,5
if RCBE1N = 5 and RCBE1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RCBE2]
else [goto MAMHAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.230_00.000
Variable Name
MAMHAD
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults age 30+
Question Text
Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against
the breast.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text " A mammogram is an x-ray taken only of the breast by a machine that
presses against the breast." in BOLD GRAY text.
Skip Instructions
<1> [goto MAM6YR] <2> [goto MDRECMAM] if AGE GE 40 [goto CHESTX];
else [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 63 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.250_00.000
Variable Name
MAM6YR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
How many mammograms have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more mammograms.
Answer Codes
0-95
Refused
Don't Know
Question Type
Interger
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-95,R,D> [goto RMAM1_MT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_01.000
Variable Name
RMAM1_MT
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
1 of 2
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if RMAM1_MT = store 'R' in RMAM1_YR
if RMAM1_MT = <96> store '9996' in RMAM1_YR
Skip Instructions
<1-12,D> [goto RMAM1_YR] store "R' in RMAM1_YR [goto RMAM2] <96> store
"9996" in RMAM1_YR [goto RMAM1N]
Hard Edits
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AssocHelp
Monday, August 25, 2014
Page 65 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_02.000
Variable Name
RMAM1_YR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and ('01' <= RMAM1_MT <= '12' or RMAM1_MT='99')
Universe-text
Female sample adults age 30+ who answered month of last mammogram or didn't
know month of last mammogram
Question Text
2 of 2
*Enter year of last mammogram.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RMAM1_YR gt current year or (RMAM1_YR=current year and
RMAM1_MT gt current month)
goto ERR1_ RMAM1_YR (future date)
elseif RMAM1_YR lt DOBY or (RMAM1_YR=DOBY and RMAM1_MT lt DOBM)
goto ERR2_ RMAM1_YR (prior to birth date)
elseif RMAM1_MT=D
goto RMAM2
elseif RMAM1_MT=1-12
goto MAMPAY
goto RMAM2
Hard Edits
ERR1_ RMAM1_YR
* Future date invalid. Please correct.
ERR2_ RMAM1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 66 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_01.000
Variable Name
RMAM1N
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96'
Universe-text
Female sample adults 30+ who selected number and time period format for most
recent mammogram from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RMAM1N = store 'R' in RMAM1T
if RMAM1N = store 'D' in RMAM1T
Skip Instructions
<1-95> [goto RMAM1T] store "R,D" in RMAM1T [goto RMAM2]
Hard Edits
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AssocHelp
Monday, August 25, 2014
Page 67 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_02.000
Variable Name
RMAM1T
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96' and ('01' <= RMAM1N <= '95')
Universe-text
Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent mammogram.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2.
if RMAM1N=4 and RMAM1T=4, store '4' in RMAM2.
Skip Instructions
<1-3> goto MAMPAY
<4> if RMAM1N=4
set RMAM2=4
goto MAMPAY
elseif RMAM1N gt 5 and RMAM1N gt AGE
goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE
set RMAM2=5
goto MAMPAY
elseif RMAM1N=1,2,3,5
goto RMAM2
goto RMAM2
Hard Edits
ERR_RMAM1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 68 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.275_00.000
Variable Name
RMAM2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and (RMAM1_MT(e) IN ('97','98','99') or RMAM1_YR(e) IN
('9997','9998','9999') or RMAM1N(e) IN ('97','98','99') or RMAM1T(e) IN ('7','8','9') or
(RMAM1T(e) = '4' and RMAM1N IN ('1','2','3','5')))
Universe-text
Female sample adults 30+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last mammogram
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2 and don't ask question.
If RMAM1N=4 and RMAM1T=4, store '4' in RMAM2 and don't ask question.
Based upon prior answers:
if RMAM1N = 1 and RMAM1T = '4', gray out answer codes 3,4,5
if RMAM1N = 2 and RMAM1T = '4', gray out answer codes 1,4,5
if RMAM1N = 3 and RMAM1T = '4', gray out answer codes 1,2,5
if RMAM1N = 5 and RMAM1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RMAM2]
else [goto MAMPAY]
Hard Edits
ERR_RMAM2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 69 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.280_00.000
Variable Name
MAMPAY
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who who have ever had a mammogram
Question Text
How much did you pay out of pocket for this mammogram -- was it NONE, PART, or
ALL of the cost?
Answer Codes
1. None of the cost
2. Part of the cost
3. All of the cost
Refused
Don't Know
Question Type
Pick one-answer list pane
Field Pane Description
Pay for mammogram
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MAMREAS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 70 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.310_00.000
Variable Name
MAMREAS
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
What was the MAIN reason you had this mammogram -- was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MDRECMAM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 71 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.315_00.000
Variable Name
MDRECMAM
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e) not IN ('7','9')
Universe-text
Female sample adults 30+ who have not answered Refused or Don't know to ever
having a mammogram
Question Text
Fill1 (IF MAMHAD=1 and most recent screening exam LE 2 years from system date)
[Was your most recent mammogram recommended by a doctor or other health
professional?]
Else (IF MAMHAD=2, or MAMHAD GT 2 years from system date or RMAM2=R,D)
[In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED
that you have a mammogram?]
Answer Codes
1. Yes
2. No
3. Did not see a doctor in the last 12 months
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
[fill 1] if MAMHAD = '1' and ((RMAM2 = 1,2) or (RMAM1T = 1,2) or (RMAM1_YR =
(current year – 2) and RMAM1_MT ge current month) or (RMAM1_YR gt (current year –
2)) or (RMAM1T = 3 and RMAM1N le 24))
fill " Was your most recent mammogram recommended by a doctor or other health
professional?"
else
fill "In the PAST 12 MONTHS, has a doctor or other health professional
RECOMMENDED that you have a mammogram?"
Special Instructions
Skip Instructions
<1-3,R,D> if MAMHAD=1 [goto MAMDNBR]; else if AGE GE 40 [goto CHESTX]; else
[goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 72 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.317_00.000
Variable Name
MAMDNBR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who who have ever had a mammogram
Question Text
Were you informed that your mammogram showed that you have dense breast tissue?
Answer Codes
1. Yes
2. No
3. Did not see a doctor in the last 12 months
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Dense breasts
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MAMABN1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 73 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.320_00.000
Variable Name
MAMABN1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
After your MOST RECENT mammogram, were you advised to have more tests?
*Read if necessary: More tests may include another mammogram, a sonogram, an
MRI, a biopsy, or something else to check for problems in your breast.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "More tests may include another mammogram, a sonogram, an MRI, a
biopsy, or something else to check for problems in your breast." in BOLD GRAY text.
Skip Instructions
<1> [goto MFOLLOW1] <2,R,D> [goto LUMPEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 74 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.325_00.000
Variable Name
MFOLLOW1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and MAMABN1(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram and was recommended
to have more tests
Question Text
Which tests did you actually have?
*Enter all that apply, separate with commas.
Answer Codes
0. None
1. Ultrasound
2. Breast MRI
3. Additional mammogram(s)
4. Biopsy
5. Other
Refused
Don’t know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
Special Instructions Do not allow '0' with other answer categories.
Skip Instructions
<0> [goto MNOTFOL1]
<1-5,R,D> [goto MAMCAN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 75 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.330_00.000
Variable Name
MNOTFOL1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and MFOLLOW1(e)='0'
Universe-text
Female sample adults 30+ who have ever had a mammogram and did not follow
recommendation to have more tests
Question Text
What is the most important reason why you DID NOT follow the recommendation to
have more tests?
*Put response into correct category below.
Answer Codes
1. No reason/never thought about it
2. Put it off/didn't get around to it
3. Too expensive/no insurance/cost
4. Too painful, unpleasant, or embarrassing
5. I'm too young
6. Don't have doctor
7. Fear
8. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-8,R,D> [goto MAMMODE]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 76 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.335_00.000
Variable Name
MAMMODE
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and MFOLLOW(e)='2'
Universe-text
Female sample adults 30+ who have ever had a mammogram and did not follow
recommendation to have more tests
Question Text
*Record mode of previous question.
Answer Codes
1. In person
2. Over the telephone
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Do not allow Refused or Don't know
Skip Instructions
<1,2> [goto LUMPEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 77 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.340_00.000
Variable Name
MAMCAN
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMABN1(e)='1' and MFOLLOW1(e) IN('1','2','3','4','5')
Universe-text
Female sample adults 30+ who followed recommendation for follow-up after a
mammogram
Question Text
As a result of these additional tests after your mammogram(s), were you diagnosed
with cancer?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LUMPEV2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 78 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.350_00.000
Variable Name
LUMPEV2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
Have you EVER HAD a biopsy to test or remove a lump from your breast that was
found NOT to be cancer?
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether
cancer cells are present.
Answer Codes
1. Yes
2. No
3. Lump removed was cancerous
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the text " A biopsy is the removal of a sample of tissue to see whether cancer
cells are present." in BOLD GRAY text.
Skip Instructions
<1> [goto LUMPNUM2]
<2,3,R,D> if age ge 40 [goto CHESTX]; else [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 79 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.351_00.000
Variable Name
LUMPNUM2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
LUMPEV2(e)='1'
Universe-text
Female sample adults 30+ who have had a lump removed that was not cancerous
Question Text
How many of these biopsies have you had?
*Enter '95' if 95 or more biopsies
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether
cancer cells are present
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Display the text "A biopsy is the removal of a sample of tissue to see whether cancer
cells are present." in BOLD GRAY text.
Skip Instructions
<1-95,R,D> if age ge 40 [goto CHESTX]; else [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 80 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_01.000
Variable Name
CHESTX
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
The next set of questions is about tests of your chest area. These questions ask about
chest x-rays and CT scans, but not mammograms.
In the last 12 months, did you have a chest x-ray?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHESTREA]
<2,D,R> [goto CATEVER]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 81 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_02.000
Variable Name
CHESTREA
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CHESTX(e)='1'
Universe-text
Sample adults 40+ who have had a chest xray in the past 12 months
Question Text
Were any of the chest x-rays you had in the last 12 months done to check for lung
cancer, rather than for some other reason?
Answer Codes
1. Yes, to check for lung cancer
2. No, for some other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto CATEVER]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 82 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_03.000
Variable Name
CATEVER
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
The following questions are about CT scans, also called CAT scans. During this test,
you are lying down and moved through a donut shaped x-ray machine while holding
your breath.
Have you EVER HAD a CT or CAT scan?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CATCHST1]
<2,D,R> [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 83 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_04.000
Variable Name
CATCHST1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CATEVER(e)='1'
Universe-text
Sample adults 40+ who have ever had a CAT scan or CT scan
Question Text
Were any of the CT or CAT scans you had done of your chest area?
Answer Codes
1. Yes
2. No
3. Several areas of upper body region
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,3> [goto CATLUNG1]
<2,D,R> [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 84 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_05.000
Variable Name
CATLUNG1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CATCHST1(e) IN
('1',3)
Universe-text
Sample adults 40+ who have had a CAT scan or CT scan of the chest area in the past
12 months
Question Text
The next questions are only about CT or CAT scans to check or screen for lung cancer.
Do not include any CT or CAT scans of your chest area that were done for other
reasons.
Were any of the CAT scans of your chest area done to check for lung cancer, rather
than for some other reason?
Answer Codes
1. Yes, to check for lung cancer
2. No, for some other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CATWHEN] <2,R,D> [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 85 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_06.000
Variable Name
CATWHEN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CATLUNG1(e)='1'
Universe-text
Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen
for lung cancer
Question Text
When did you have your MOST RECENT CT or CAT scan of your chest area to check
or screen for lung cancer?
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Most recent CT/CAT scan
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto CATNUM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 86 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_07.000
Variable Name
CATNUM
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CATLUNG1(e)='1'
Universe-text
Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen
for lung cancer
Question Text
How many CT or CAT scans to check or screen for lung cancer have you had in the
LAST 3 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more CT scans
Answer Codes
Allow 0-95,R,D
Question Type
Integer
Field Pane Description
Number of scans
Fill Instructions
Special Instructions
Skip Instructions
<0-95,R,D> [goto CATNEXT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 87 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.423_08.000
Variable Name
CATNEXT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CATLUNG1(e)='1'
Universe-text
Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen
for lung cancer
Question Text
When do you expect to have your next CT scan of your chest area to check or screen
for lung cancer?
Answer Codes
1. Less than a year from now
2. One year from now
3. More than one year from now
4. When doctor recommends it
5. Never
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Next scan
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ASPIRIN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 88 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_02.000
Variable Name
ASPIRIN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Do you now take any of the following medications regularly, that is, at least 3 times a
week?
Aspirin, Bayer, Bufferin, or Excedrin?
*Read if necessary: Do NOT include Tylenol.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "Do NOT include Tylenol." in BOLD GRAY text.
Skip Instructions
<1> [goto ASPIR3M] <2,D,R> [goto ADVIL]
Hard Edits
Soft Edits
AssocHelp
H_ASPIRIN
Monday, August 25, 2014
Page 89 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_02.000_H
Variable Name
H_ASPIRIN
Universe
Universe-text
Question Text
Include any medications that contain aspirin. Do not include steroid medications, such
as prednisone.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: ASPIRIN
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 90 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_03.000
Variable Name
ASPIR3M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ASPIRIN(e)='1'
Universe-text
Sample adults 18+ who now take Aspirin etc.
Question Text
Have you taken any of these kinds of medications regularly for the last 3 months?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ADVIL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 91 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_04.000
Variable Name
ADVIL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you now take any of the following medications regularly, that is, at least 3 times a
week?
Advil, Ibuprofen, Motrin, Nuprin, Aleve, Naprosyn, Naproxen, or Celebrex?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ADVIL3M]
<2,R,D> [goto ACETOCT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 92 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_05.000
Variable Name
ADVIL3M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ADVIL(e)='1'
Universe-text
Sample adults 18+ who now take Advil etc.
Question Text
Have you taken any of these kinds of medications regularly for the last 3 months?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ACETOCT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 93 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_05.010
Variable Name
ACETOCT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you now take any OVER-THE-COUNTER MEDICATIONS that contain
acetaminophen regularly, that is, at least 3 times a week? Acetaminophen is contained
in many products such as Tylenol, Tylenol PM, Nyquil, Theraflu, Excedrin, Alka Seltzer
Plus, and Midol.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ACETOC3M] <2,R,D> [goto ACETPR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 94 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_05.020
Variable Name
ACETOC3M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ACETOCT(e)='1'
Universe-text
Sample adults 18+ who take over the counter acetaminophen
Question Text
Have you taken any of these kinds of medications regularly for the last 3 months?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ACETPR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 95 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_05.030
Variable Name
ACETPR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you now take any of the following PRESCRIPTION PAIN MEDICATIONS that
contain acetaminophen regularly, that is, at least 3 times a week? Acetaminophen is
contained in many prescription pain products such as Vicodin, Percocet, Endocet,
Tylenol with Codeine, and Fioricet.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ACETPR3M] <2,R,D> if SEX=1 [goto PROPECIA]
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 96 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_05.040
Variable Name
ACETPR3M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ACETPR(e)='1'
Universe-text
Sample adults 18+ who take prescription acetaminophen
Question Text
Have you taken any of these kinds of medications regularly for the last 3 months?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if SEX=1 [goto PROPECIA]
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 97 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_06.000
Variable Name
PROPECIA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 18+
Question Text
Some men take medications such as Propecia (pro-PEE-she-ah), Proscar (PRAHScar) or Finasteride (fin-AS-tur-eyed) for hair loss or for problems with their prostate
gland. Do you now take any of these medications regularly, that is, at least 3 times a
week?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PROPMTHS]
<2,R,D> if AGE ge 40 [goto PSAHAD]
elseif AGE = 18-39 [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 98 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_07.000
Variable Name
PROPMTHS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='1' and
PROPECIA(e)='1'
Universe-text
Male sample adults 18+ who take Propecia regularly
Question Text
Have you taken Propecia, Proscar or Finasteride regularly for the last 3 months?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PROPREAS]
<2,R,D> if AGE ge 40 [goto PSAHAD]
elseif AGE = 18-39 [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 99 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.424_08.000
Variable Name
PROPREAS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='1' and
PROPMTHS(e)='1'
Universe-text
Male sample adults 18+ who have taken Propecia regularly for last 3 months
Question Text
What is the main reason you are taking Propecia, Proscar or Finasteride?
*Read categories below.
Answer Codes
1. For problems related to your prostate
2. For male pattern baldness
3. To reduce the chance that you may develop prostate cancer
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-4 in BOLD BLACK text.
Skip Instructions
<1-4,R,D> if AGE ge 40 [goto PSAHAD]
elseif AGE = 18-39 [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 100 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_01.000
Variable Name
MEDHRT
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 30+
Question Text
Are you currently taking Hormone Replacement Therapy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto MEDTAMX]
<2,R,D> [goto HRTEVER]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 101 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_02.000
Variable Name
HRTEVER
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MEDHRT(e) IN ('2','7','9')
Universe-text
Female sample adults 30+ who are not currently taking HRT
Question Text
Have you ever taken Hormone Replacement Therapy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HRTSTOP]
<2,R,D> [goto MEDTAMX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 102 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_03.000
Variable Name
HRTSTOP
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
HRTEVER(e)='1'
Universe-text
Female sample adults 30+ who have ever taken HRT but not currently
Question Text
About how long ago did you stop using Hormone Replacement Therapy -- was it 2
years ago or less, more than 2 years ago but not more than 5 years, or more than 5
years ago?
Answer Codes
1. 2 years ago or less
2. more than 2 years ago but not more than 5 years
3. more than 5 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto MEDTAMX
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 103 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_04.000
Variable Name
MEDTAMX
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 30+
Question Text
Are you currently taking Tamoxifen, also known as Nolvadex?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto TAMMAIN]
<2,R,D> [goto MEDRALX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 104 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_05.000
Variable Name
TAMMAIN
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MEDTAMX(e)='1'
Universe-text
Female sample adults 30+ who are currently taking tamoxifen
Question Text
What is the main reason you are taking tamoxifen?
*Put response into correct category below.
Answer Codes
1. As part of your treatment for breast cancer
2. To reduce the chance that you may develop breast cancer
3. Both
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MEDRALX] <4> [goto TAMOXSP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 105 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_05.010
Variable Name
TAMOXSP
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
TAMMAIN(e)='4'
Universe-text
Female sample adults 30+ who are currently taking tamoxifen for other reason
Question Text
*Enter other reason for taking tamoxifen.
Answer Codes
Allow verbatim, R,D
Question Type
Verbatim
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
[goto MEDRALX]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 106 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_06.000
Variable Name
MEDRALX
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 30+
Question Text
Are you currently taking Raloxifene (rah-LOX-ih-fen), also known as Evista?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto RALXREAS]
<2,R,D> [goto MEDBC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 107 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_07.000
Variable Name
RALXREAS
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MEDRALX(e)='1'
Universe-text
Female sample adults 30+ who are currently taking raloxifene
Question Text
What is the main reason you are taking raloxifene?
*Put response into correct category below.
Answer Codes
1. As part of my treatment for osteoporosis
2. To reduce the chance that I may develop breast cancer
3. Both
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MEDBC] <4> [goto RALOXSP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 108 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_07.010
Variable Name
RALOXSP
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
RALXREAS(e)='4'
Universe-text
Female sample adults 30+ who are currently taking raloxifen for other reason
Question Text
*Enter other reason for taking raloxifen.
Answer Codes
Allow verbatim, R,D
Question Type
Verbatim
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
[goto MEDBC]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 109 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.425_08.000
Variable Name
MEDBC
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+
Question Text
Are you currently taking birth control pills, birth control implants, or birth control shots?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AGE ge 40 [goto COLDIS]; elseif AGE=18-39 [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 110 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.430_00.000
Variable Name
PSAHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and SEX='1')
Universe-text
Male sample adults 40+
Question Text
Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also
called a prostate-specific antigen test.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "A PSA test is a blood test to detect prostate cancer. It is also called a
prostate-specific antigen test. " in BOLD GRAY text.
Skip Instructions
<1> [goto RPSA1_MT] <2,R,D> [goto PSAADV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 111 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_00.000
Variable Name
RPSA1_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
1 of 2
When did you have your MOST RECENT PSA test?
* Enter month of last PSA test.
* Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if RPSA1_MT = store 'R' in RPSA1_YR
if RPSA1_MT = <96> store '9996' in RPSA1_YR
Skip Instructions
<1-12,D> [goto RPSA1_YR] store "R' in RPSA1_YR [goto RPSA2] <96> store
"9996" in RPSA1_YR [goto RPSA1N]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 112 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_01.000
Variable Name
RPSA1_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and ('01' <= RPSA1_MT <= '12' or RSPA1_MT='99')
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
2 of 2
* Enter year of last PSA test.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPSA1_YR gt current year or (RPSA1_YR=current year and
RPSA1_MT gt current month)
goto ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM)
goto ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D
goto RPSA2
elseif RPSA1_MT=1-12
goto PSAREAS
goto RPSA2
Hard Edits
ERR1_ RPSA1_YR
* Future date invalid. Please correct.
ERR2_ RPSA1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 113 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_02.000
Variable Name
RPSA1N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96'
Universe-text
Male sample adults 40+ who have selected number and time period format for most
recent PSA test from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RPSA1N = store 'R' in RPSA1T
if RPSA1N = store 'D' in RPSA1T
Skip Instructions
<1-95> [goto RPSA1T] store "R,D" in RPSA1T [goto RPSA2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 114 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_03.000
Variable Name
RPSA1T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96' and ('01' <= RPSA1N <= '95')
Universe-text
Male sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
* Enter time period for time since most recent PSA test.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2.
Skip Instructions
<1-3> goto PSAREAS
<4> if RPSA1N=4
set RPSA2=4
goto PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE
goto ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
goto PSAREAS
elseif RPSA1N=1,2,3,5
goto RPSA2
goto RPSA2
Hard Edits
ERR_RPSA1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 115 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_04.000
Variable Name
RPSA2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and (RPSA1_MT(e) IN ('97','98','99') or RPSA1_YR(e) IN
('9997','9998','9999') or RPSA1N(e) IN ('97','98','99') or RPSA1T(e) IN ('7','8','9') or
(RPSA1T(e) = '4' and RPSA1N IN ('1','2','3','5')))
Universe-text
Male sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last PSA test was
over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2 and don't ask question.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2 and don't ask question.
Based upon prior answers:
if RPSA1N = 1 and RPSA1T = '4', gray out answer codes 3,4,5
if RPSA1N = 2 and RPSA1T = '4', gray out answer codes 1,4,5
if RPSA1N = 3 and RPSA1T = '4', gray out answer codes 1,2,5
if RPSA1N = 5 and RPSA1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPSA2] else [goto PSAREAS]
Hard Edits
ERR_RPSA2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 116 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.441_00.000
Variable Name
PSAREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
What was the MAIN reaso you had this PSA test - was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSASUGG]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 117 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.445_00.000
Variable Name
PSASUGG
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
Who first suggested the PSA test: you, your doctor, or someone else?
Answer Codes
1. Self
2. Doctor
3. Someone else
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSA5YR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 118 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.450_00.000
Variable Name
PSA5YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
How many PSA tests have you had in the LAST 5 years?
*Enter '0' for none.
*Enter '95" for 95 or more PSA tests.
Answer Codes
Allow 0-95, R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-95,R,D> [goto PSAADV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 119 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.455_00.000
Variable Name
PSAADV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
advantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSADISAV]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 120 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.460_00.000
Variable Name
PSADISAV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
disadvantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSAEXP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 121 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.470_00.000
Variable Name
PSAEXP
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER tell you that some experts
disagree about whether men should have PSA tests?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLDIS]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 122 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.500_00.000
Variable Name
COLDIS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Have you and your doctor or other health professional ever DISCUSSED getting a test
to check for colon cancer?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLHAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 123 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.540_00.000
Variable Name
COLHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
There are several different kinds of tests to check for colon cancer. Colonoscopy
(colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor
inserts a tube into the rectum to look for polyps or cancer. For a colonoscopy, the
doctor checks the entire colon, and you are given medication through a needle in your
arm to make you sleepy, and told to have someone drive you home. For a
Sigmoidoscopy, the doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "A polyp is a small growth that develops on the inside of the colon or
rectum." in BOLD GRAY text.
Display the text "Before these tests, you are asked to take a medication that causes
diarrhea." in BOLD GRAY text.
Skip Instructions
<1> [goto COL_MT] <2,R,D> [goto SIGHAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 124 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_01.000
Variable Name
COL_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if COL_MT = store 'R' in COL_YR
if COL_MT = <96> store '9996' in COL_YR
Skip Instructions
<1-12,D> [goto COL_YR] store "R' in COL_YR [goto COL2] <96> store "9996" in
COL_YR [goto COLN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 125 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_02.000
Variable Name
COL_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and ('01' <= COL_MT <= '12' or COL_MT='99')
Universe-text
Sample adults age 40+ who answered month of last colonoscopy or didn't know month
of last colonoscopy
Question Text
2 of 2
*Enter year of last colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if COL_YR gt current year or (COL_YR=current year and COL_MT gt
current month)
goto ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or (COL_YR=DOBY and COL_MT lt DOBM)
goto ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D
goto COL2
elseif COL_MT=1-12
goto COLREAS
goto COL2
Hard Edits
ERR1_ COL_YR
* Future date invalid. Please correct.
ERR2_ COL_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 126 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_01.000
Variable Name
COLN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
colonoscopy from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if COLN = store 'R' in COLT
If COLN = store 'D' in COLT
Skip Instructions
<1-95> [goto COLT] store "R,D" in COLT [goto COL2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 127 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_02.000
Variable Name
COLT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96' and ('01' <= COLN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent colonoscopy.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If COLN gt 10 and COLT=4, store '6' in COL2.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2.
If COLN=4 and COLT=4, store '4' in COL2.
Skip Instructions
<1-3> goto COLREAS
<4> if COLN=4
set COL2=4
goto COLREAS
elseif COLN=6,7,8,9
set COL2=5
goto COLREAS
elseif COLN gt 10 and COLN gt AGE
goto ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
goto COLREAS
elseif COLN=1,2,3,5,10
goto COL2
goto COL2
Hard Edits
ERR_COLT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Monday, August 25, 2014
Page 128 of 170
AssocHelp
Monday, August 25, 2014
Page 129 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.575_00.000
Variable Name
COL2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and (COL_MT(e) IN ('97','98','99') or COL_YR(e) IN ('9997','9998','9999') or COLN(e)
IN ('97','98','99') or COLT(e) IN ('7','8','9') or (COLT(e)='4' and COLN IN
('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last colonoscopy was 6-9 or over
10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If COLN gt 10 and COLT=4, store '6' in COL2 and don't ask question.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2 and don't ask question.
If COLN=4 and COLT=4, store '4' in COL2 and don't ask question.
Based upon prior answers:
if COLN = 1 and COLT = '4', gray out answer codes 3,4,5,6
if COLN = 2 and COLT = '4', gray out answer codes 1,4,5,6
if COLN = 3 and COLT = '4', gray out answer codes 1,2,5,6
if COLN = 5 and COLT = '4', gray out answer codes 1,2,3,6
if COLN = 10 and COLT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_COL2] else [goto COLREAS]
Hard Edits
ERR_COL2
*That is not a valid response.
*Please correct.
Monday, August 25, 2014
Page 130 of 170
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.590_00.000
Variable Name
COLREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who have had a colonoscopy
Question Text
What was the MAIN reason you had this colonoscopy - was it part of a routine exam,
because of a problem, as a follow-up test of an earlier test or screening exam, or some
other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Follow-up test of an earlier test or screening exam
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto COLPAY]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 131 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.590_00.010
Variable Name
COLPAY
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who who have ever had a colonoscopy
Question Text
How much did you pay out of pocket for this colonoscopy -- was it NONE, PART, or
ALL of the cost?
Answer Codes
1. None of the cost
2. Part of the cost
3. All of the cost
Refused
Don't Know
Question Type
Pick one-answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SIGHAD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 132 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.591_00.000
Variable Name
SIGHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Recall that a sigmoidoscopy is similar to a colonoscopy but the doctor checks only part
of the colon and you are fully awake. Have you EVER HAD a sigmoidoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SIG_MT] <2,R,D> [goto CTHEARD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 133 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.592_01.000
Variable Name
SIG_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a sigmoidoscopy
Question Text
1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if SIG_MT = store 'R' in SIG_YR
if SIG_MT = <96> store '9996' in SIG_YR
Skip Instructions
<1-12,D> [goto SIG_YR] store "R' in SIG_YR [goto SIG2] <96> store "9996" in
SIG_YR [goto SIGN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 134 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.593_02.000
Variable Name
SIG_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
('01' <= SIG_MT <= '12' or SIG_MT='99')
Universe-text
Sample adults age 40+ who answered month of last sigmoidoscopy or didn't know
month of last sigmoidoscopy
Question Text
2 of 2
*Enter year of last sigmoidoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if SIG_YR gt current year or (SIG_YR=current year and SIG_MT gt current
month)
goto ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM)
goto ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D
goto SIG2
elseif SIG_MT=1-12
goto SIGREAS
goto SIG2
Hard Edits
ERR1_ SIG_YR
* Future date invalid. Please correct.
ERR2_ SIG_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 135 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.594_01.000
Variable Name
SIGN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
SIG_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
sigmoidoscopy from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter number for time since last sigmoidoscopy.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if SIGN = store 'R' in SIGT
If SIGN = store 'D' in SIGT
Skip Instructions
<1-95> [goto SIGT] store "R,D" in SIGT [goto SIG2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 136 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.595_02.000
Variable Name
SIGT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
SIG_MT(e)='96' and ('01' <= SIGN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent sigmoidoscopy.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If SIGN gt 10 and SIGT=4, store '6' in SIG2.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2.
If SIGN=4 and SIGT=4, store '4' in SIG2.
Skip Instructions
<1-3> goto SIGREAS
<4> if SIGN=4
set SIG2=4
goto SIGREAS
elseif SIGN=6,7,8,9
set SIG2=5
goto SIGREAS
elseif SIGN gt 10 and SIGN gt AGE
goto ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
goto SIGREAS
elseif SIGN=1,2,3,5,10
goto SIG2
goto SIG2
Hard Edits
ERR_SIGT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Monday, August 25, 2014
Page 137 of 170
AssocHelp
Monday, August 25, 2014
Page 138 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.596_00.000
Variable Name
SIG2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
(SIG_MT(e) IN ('97','98','99') or SIG_YR(e) IN ('9997','9998','9999') or SIGN(e) IN
('97','98','99') or SIGT(e) IN ('7','8','9') or (SIGT(e)='4' and SIGN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last sigmoidoscopy was 6-9 or
over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If SIGN gt 10 and SIGT=4, store '6' in SIG2 and don't ask question.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2 and don't ask question.
If SIGN=4 and SIGT=4, store '4' in SIG2 and don't ask question.
Based upon prior answers:
if SIGN = 1 and SIGT = '4', gray out answer codes 3,4,5,6
if SIGN = 2 and SIGT = '4', gray out answer codes 1,4,5,6
if SIGN = 3 and SIGT = '4', gray out answer codes 1,2,5,6
if SIGN = 5 and SIGT = '4', gray out answer codes 1,2,3,6
if SIGN = 10 and SIGT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out {goto ERR_SIG2] else [goto SIGREAS]
Hard Edits
ERR_SIG2
*That is not a valid response.
*Please correct.
Soft Edits
Monday, August 25, 2014
Page 139 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.597_00.000
Variable Name
SIGREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
Universe-text
Sample adults 40+ who have had a sigmoidoscopy
Question Text
What was the MAIN reason you had this sigmoidoscopy - was it part of a routine exam,
because of a problem, as a follow-up test of an earlier test or screening exam, or some
other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Follow-up test of an earlier test or screening exam
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto CTHEARD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 140 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.611_00.000
Variable Name
CTHEARD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
CT colonography, sometimes called virtual colonoscopy, is a new type of test that looks
for cancer in the colon. Unlike regular colonoscopies, you do not need medication to
make you sleepy during the test. In this new test, your colon is filled with air and you are
moved through a donut-shaped X-ray machine as you lie on your back and then your
stomach.
Before today, HAD YOU EVER HEARD of CT colonography or virtual colonoscopy?
*Read if necessary:
This is not the same as a colonoscopy or a sigmoidoscopy.
Unlike CT tests for other purposes, you DO take laxatives to clean out your colon for
this test.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "This is not the same as a colonoscopy or a sigmoidoscopy. " in BOLD
GRAY text.
Display the text " Unlike CT tests for other purposes, you DO take laxatives to clean out
your colon for this test." in BOLD GRAY text.
Skip Instructions
<1> [goto CTHADEV]
<2,R,D> [goto POLYP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 141 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.612_00.000
Variable Name
CTHADEV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHEARD(e)='1'
Universe-text
Sample adults 40+ who have ever heard of a CT colonography or a virtual colonoscopy
Question Text
Have you EVER HAD a CT colonography or virtual colonoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CT_MT] <2,R,D> [goto POLYP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 142 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.613_01.000
Variable Name
CT_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
Universe-text
Sample adults 40+ who have ever had a CT colonography or virtual colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter month of last CT colonography or virtual colonoscopy.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if CT_MT = store 'R' in CT_YR
if CT_MT = <96> store '9996' in CT_YR
Skip Instructions
<1-12,D> [goto CT_YR] store "R' in CT_YR [goto CT2] <96> store "9996" in
CT_YR [goto CTN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 143 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.614_02.000
Variable Name
CT_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and ('01' <= CT_MT <= '12' or CT_MT='99')
Universe-text
Sample adults age 40+ who answered month of last CT colonography or virtual
colonoscopy or didn't know month of last CT colonography or virtual colonoscopy
Question Text
2 of 2
*Enter year of last CT colonography or virtual colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if CT_YR gt current year or (CT_YR=current year and CT_MT gt current
month)
goto ERR1_ CT_YR (future date)
elseif CT_YR lt DOBY or (CT_YR=DOBY and CT_MT lt DOBM)
goto ERR2_ CT_YR (prior to birth date)
elseif CT_MT=D
goto CT2
elseif CT_MT=1-12
goto CTREAS
goto CT2
Hard Edits
ERR1_ CT_YR
* Future date invalid. Please correct.
ERR2_ CT_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 144 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.615_01.000
Variable Name
CTN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent CT
colonography or virtual colonoscopy from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter number for time since last CT colonography or virtual colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if CTN = store 'R' in CTT
If CTN = store 'D' in CTT
Skip Instructions
<1-95> [goto CTT] store "R,D" in CTT [goto CT2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 145 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.616_02.000
Variable Name
CTT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96' and ('01' <= CTN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent CT colonography or virtual colonoscopy.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If CTN gt 10 and CTT=4, store '6' in CT2.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2.
If CTN=4 and CTT=4, store '4' in CT2.
Skip Instructions
<1-3> goto CTREAS
<4> if CTN=4
set CT2=4
goto CTREAS
elseif CTN=6,7,8,9
set CT2=5
goto CTREAS
elseif CTN gt 10 and CTN gt AGE
goto ERR_CTT (greater than persons age)
elseif CTN gt 10 and CTN le AGE
set CT2=6
goto CTREAS
elseif CTN=1,2,3,5,10
goto CT2
goto CT2
Hard Edits
ERR_CTT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Monday, August 25, 2014
Page 146 of 170
AssocHelp
Monday, August 25, 2014
Page 147 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.617_00.000
Variable Name
CT2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and (CT_MT(e) IN ('97','98','99') or CT_YR(e) IN ('9997','9998','9999') or CTN(e) IN
('97','98','99') or CTT(e) IN ('7','8','9') or (CTT(e) = '4' and CTN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last CT colonography or virtual
colonoscopy was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If CTN gt 10 and CTT=4, store '6' in CT2 and don't ask question.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2 and don't ask question.
If CTN=4 and CTT=4, store '4' in CT2 and don't ask question.
Based upon prior answers:
if CTN = 1 and CTT = '4', gray out answer codes 3,4,5,6
if CTN = 2 and CTT = '4', gray out answer codes 1,4,5,6
if CTN = 3 and CTT = '4', gray out answer codes 1,2,5,6
if CTN = 5 and CTT = '4', gray out answer codes 1,2,3,6
if CTN = 10 and CTT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_CT2] else [goto CTREAS]
Hard Edits
ERR_CT2
*That is not a valid response.
*Please correct.
Soft Edits
Monday, August 25, 2014
Page 148 of 170
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.618_00.000
Variable Name
CTREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
Universe-text
Sample adults 40+ who have had a CT colonography or virtual colonoscopy
Question Text
What was the MAIN reason you had this CT colonography or virtual colonoscopy - was
it part of a routine exam, because of a problem, as a follow-up test of an earlier test or
screening exam, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Follow-up test of an earlier test or screening exam
4. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto POLYP]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 149 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.619_00.000
Variable Name
POLYP
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
A polyp is a small growth that develops on the inside of the colon or rectum. During the
past 10 years did a doctor tell you that you had a polyp in your colon or rectum?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLTOLD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 150 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.619_00.010
Variable Name
COLTOLD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
The following questions are about another type of test to check for colon cancer - the
blood stool or occult blood test, or fecal immunochemical or FIT test, tests to determine
whether you have blood in your stool or bowel movement. These tests can be done at
home using a kit. You use a stick or brush to obtain a small amount of stool at home
and send it back to the doctor or lab.
Has your doctor or other health professional EVER told you about these tests for blood
in the stool to check for colon cancer?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLGOOD]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 151 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.619_00.020
Variable Name
COLGOOD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Did your doctor or other health professional say that these tests for blood in the stool
are a GOOD way to check for colon cancer?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HFOBHAD1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 152 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.620_00.000
Variable Name
HFOBHAD1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Have you EVER HAD a blood stool or FIT test, using a HOME test kit?
*Read if necessary: Do not include tests done at the doctor's office.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions Display the text "Do not include tests done at the doctor's office." In BOLD GRAY text.
Skip Instructions
<1> goto RHFO2_MT
<2,R,D> goto FOBHAD1
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 153 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_01.000
Variable Name
RHFO2_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1='1'
Universe-text
Sample adults 40+ who have ever had a home blood stool or FIT test
Question Text
1 of 2
When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter month of last home blood stool or FIT test.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if RHFO2_MT = store 'R' in RHFO2_YR
if RHFO2_MT = <96> store '9996' in RHFO2_YR
Skip Instructions
<1-12,D> goto RHFO2_YR
store "R" in RHFO2_YR and goto RHFO2
<96> store "9996" in RHFO2_YR and goto RHFO2N
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 154 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_02.000
Variable Name
RHFO2_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and ('01' <= RHFO2_MT <= '12' or RHFO2_MT='99')
Universe-text
Sample adults age 40+ who answered month of last home blood stool or FIT test or
didn't know month of last test
Question Text
2 of 2
*Enter year of last home blood stool or FIT test.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RHFO2_YR gt current year or (RHFO2_YR=current year and
RHRO1_MT gt current month)
goto ERR1_RHFO2_YR (future date)
elseif RHFO2_YR lt DOBY or (RHFO2_YR=DOBY and RHFO2_MT lt
DOBM)
goto ERR2_RHFO2_YR (prior to birth date)
elseif RHFO2_MT=D
goto RHFO2
elseif RHFO2_MT=1-12
goto HFOBREA2
goto RHFO2
Hard Edits
ERR1_ RHFO2_YR
* Future date invalid. Please correct.
ERR2_ RHFO2_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 155 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_01.000
Variable Name
RHFO2N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and RHFO2_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent home
blood stool or FIT test from the initial month screen
Question Text
1 of 2
When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter number for time since last home blood stool or FIT test.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RHFO2N = store 'R' in RHFO2T
If RHFO2N = store 'D' in RHFO2T
Skip Instructions
<1-95> [goto RHFO2T] store "R,D" in RHFO2T [goto RHFO2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 156 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_02.000
Variable Name
RHFO2T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and RHFO2_MT(e)='96' and ('01' <= RHFO2N <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent home blood stool or FIT test.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2.
Skip Instructions
<1-3> goto HFOBREA2
<4> if RHFO2N=4
set RHFO2=4
goto HFOBREA2
elseif RHFO2N=6,7,8,9
set RHFO2=5
goto HFOBREA2
elseif RHFO2N gt 10 and RHFO2N gt AGE
goto ERR_RHFO2T (greater than persons age)
elseif RHFO2N gt 10 and RHFO2N le AGE
set RHFO2=6
goto HFOBREA2
elseif RHFO2N=1,2,3,5,10
goto RHFO2
goto RHFO2
Hard Edits
ERR_RHFO2T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Monday, August 25, 2014
Page 157 of 170
AssocHelp
Monday, August 25, 2014
Page 158 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.655_00.000
Variable Name
RHFO2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and (RHFO2_MT(e) IN ('97','98','99') or RHFO2_YR(e) IN ('9997','9998','9999') or
RHFO2N(e) IN ('97','98','99') or RHFO2T(e) IN ('7','8','9') or (RHFO2T(e) = '4' and
RHFO2N IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last home blood stool or FIT test
was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2 and don't ask question.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2 and don't ask question.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2 and don't ask question.
Based upon prior answers:
if RHFO2N = 1 and RHFO2T = '4', gray out answer codes 3,4,5,6
if RHFO2N = 2 and RHFO2T = '4', gray out answer codes 1,4,5,6
if RHFO2N = 3 and RHFO2T = '4', gray out answer codes 1,2,5,6
if RHFO2N = 5 and RHFO2T = '4', gray out answer codes 1,2,3,6
if RHFO2N = 10 and RHFO2T = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_RHFO2] else [goto HFOBREA2]
Hard Edits
ERR_RHFO2
*That is not a valid response.
*Please correct.
Monday, August 25, 2014
Page 159 of 170
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.660_00.000
Variable Name
HFOBREA2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
Universe-text
Sample adults 40+ who have had a home blood stool or FIT test
Question Text
What was the MAIN reason you had this home blood stool or FIT test - was it part of a
routine exam, because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto FOBHAD1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 160 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.710_00.000
Variable Name
FOBHAD1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Have you EVER HAD a blood stool or FIT test in which your doctor or other health care
professional collected a stool sample during an office visit?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto RFOB2_MT]
<2, R, D> if ((COLHAD = 2,R,D) or (COL2 = 6) or (COL_YR = (current year – 10) and
COL_MT lt current month) or (COL_YR lt (current year – 10))) and ((SIGHAD = 2,R,D)
or (SIG2 = 5,6) or (SIG_YR = (current year – 5) and SIG_MT lt current month) or
(SIG_YR lt (current year – 5))) and ((CTHEARD = 2,R,D) or (CTHADEV = 2,R,D) or
(CT2 = 5,6) or (CT_YR = (current year – 5) and CT_MT lt current month) or (CT_YR lt
(current year – 5))) and ((HFOBHAD = 2,R,D) or (RHFO2 = 2-6) or (RHFO2_YR =
(current year – 1) and RHFO2_MT lt current month) or (RHFO2_YR lt (current year –
1)) or (RHFO2T = 2 and RHFO2N gt 52) or
(RHFO2T = 3 and RHFO2N gt 12)) [goto COLPROB1]
else [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 161 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.720_01.000
Variable Name
RFOB2_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
Universe-text
Sample adults 40+ who have ever had a office blood stool/FIT test
Question Text
1 of 2
When did you have your MOST recent OFFICE blood stool or FIT test?
*Enter month of last office blood stool/FIT test.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions if RFOB2_MT = store 'R' in RFOB2_YR
if RFOB2_MT = <96> store '9996' in RFOB2_YR
Skip Instructions
<1-12,D> [goto RFOB2_YR] store "R' in RFOB2_YR [goto RFOB2] <96> store
"9996" in RFOB2_YR [goto RFOB2N]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 162 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.720_02.000
Variable Name
RFOB2_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
and ('01' <= RFOB2_MT <= '12' or RFOB2_MT='99')
Universe-text
Sample adults 40+ who answered month of last office blood stool/FIT test or didn't
know month of last office blood stool test
Question Text
2 of 2
*Enter year of last office blood stool/FIT test.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RFOB2_YR gt current year or (RFOB2_YR=current year and
RFOB2_MT gt current month)
goto ERR1_ RFOB2_YR (future date)
elseif RFOB2_YR lt DOBY or (RFOB2_YR=DOBY and RFOB2_MT lt DOBM)
goto ERR2_ RFOB2_YR (prior to birth date)
elseif RFOB2_MT=D
goto RFOB2
elseif RFOB2_MT=1-12
goto RFOBRES1
goto RFOB2
Hard Edits
ERR1_ RFOB2_YR
* Future date invalid. Please correct.
ERR2_ RFOB2_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 163 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.730_01.000
Variable Name
RFOB2N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
and RFOB2_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent office
blood stool/FIT test from the initial month screen
Question Text
1 of 2
When did you have your MOST recent OFFICE blood stool or FIT test?
*Enter number for time since last office blood stool/FIT test.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions if RFOB2N = store 'R' in RFOB2T
If RFOB2N = store 'D' in RFOB2T
Skip Instructions
<1-95> [goto RFOB2T] store "R,D" in RFOB2T [goto RFOB2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 164 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.730_02.000
Variable Name
RFOB2T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
and RFOB2_MT(e)='96' and ('01' <= RFOB2N <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent office blood stool/FIT test.
Answer Codes
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions If RFOB2N gt 10 and RFOB2T=4, store '6' in RFOB2.
If RFOB2N=6,7,8,9 and RFOB2T=4, store '5' in RFOB2.
If RFOB2N=4 and RFOB2T=4, store '4' in RFOB2.
Skip Instructions
<1-3> goto RFOBRES1
<4> if RFOB2N=4
set RFOB2=4
goto RFOBRES1
elseif RFOB2N=6,7,8,9
set RFOB2=5
goto RFOBRES1
elseif RFOB2N gt 10 and RFOB2N gt AGE
goto ERR_RFOB2T (greater than persons age)
elseif RFOB2N gt 10 and RFOB2N le AGE
set RFOB2=6
goto RFOBRES1
elseif RFOB2N=1,2,3,5,10
goto RFOB2
goto RFOB2
Hard Edits
ERR_RFOB2T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Monday, August 25, 2014
Page 165 of 170
AssocHelp
Monday, August 25, 2014
Page 166 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.735_00.000
Variable Name
RFOB2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
and (RFOB2_MT(e) IN ('97','98','99') or RFOB2_YR(e) IN ('9997','9998','9999') or
RFOB2N(e) IN ('97','98','99') or RFOB2T(e) IN ('7','8','9') or (RFOB2T(e)='4' and
RFOB2N IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last office blood stool test/FIT
was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If RFOB2N gt 10 and RFOB2T=4, store '6' in RFOB2 and don't ask question.
If RFOB2N=6,7,8,9 and RFOB2T=4, store '5' in RFOB2 and don't ask question.
If RFOB2N=4 and RFOB2T=4, store '4' in RFOB2 and don't ask question.
Based upon prior answers:
if RFOB2N = 1 and RFOB2T = '4', gray out answer codes 3,4,5,6
if RFOB2N = 2 and RFOB2T = '4', gray out answer codes 1,4,5,6
if RFOB2N = 3 and RFOB2T = '4', gray out answer codes 1,2,5,6
if RFOB2N = 5 and RFOB2T = '4', gray out answer codes 1,2,3,6
if RFOB2N = 10 and RFOB2T = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_RFOB2] else [goto RFOBRES1]
Hard Edits
ERR_RFOB2
*That is not a valid response.
*Please correct.
Monday, August 25, 2014
Page 167 of 170
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.740_00.000
Variable Name
RFOBRES1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and FOBHAD1(e)='1'
Universe-text
Sample adults 40+ who have had an office blood stool/FIT test
Question Text
What was the MAIN reason you had this office blood stool or FIT test - was it part of a
routine exam, because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if ((COLHAD = 2) or (COL2 = 6) or (COL_YR = (current year – 10) and
COL_MT lt current month) or (COL_YR lt (current year – 10))) and ((SIGHAD = 2) or
(SIG2 = 5,6) or (SIG_YR = (current year – 5) and SIG_MT lt current month) or (SIG_YR
lt (current year – 5))) and ((CTHEARD = 2) or (CTHADEV = 2) or (CT2 = 5,6) or
(CT_YR = (current year – 5) and CT_MT lt current
month) or (CT_YR lt (current
year – 5))) and ((HFOBHAD = 2) or (RHFO2 = 2-6) or
(RHFO2_YR = (current year – 1) and RHFO2_MT lt current month) or (RHFO2_YR lt
(current year – 1)) or (RHFO2T = 2 and RHFO2N gt 52) or (RHFO2T = 3 and
RHFO2N gt 12)) [goto COLPROB1]
else [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 168 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.750_00.000
Variable Name
COLPROB1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and
((COLHAD = ‘2’) or (COL2 = ‘6’) or (COL_YR = (current year – 10) and COL_MT lt
current month) or (COL_YR lt (current year – 10)) or (COLT = '4' and COLN ge '11' and
COL2 IN ('7','9'))) and
((SIGHAD = ‘2’) or (SIG2 IN (‘5’,’6’)) or (SIG_YR = (current year – 5) and SIG_MT lt
current month) or (SIG_YR lt (current year – 5)) or (SIGT = ‘3’ and SIGN gt ‘60’) or
(SIGT = '4' and SIGN ge '6' and SIG2 IN ('7','9'))) and
((CTHEARD = 2) or (CTHADEV = 2) or (CT2 IN (‘5’,’6’)) or (CT_YR = (current year – 5)
and CT_MT lt current month) or (CT_YR lt (current year – 5)) or (CTT = ‘3’ and CTN gt
‘60’) or (CTT = '4' and CTN ge '6' and CT2 IN ('7','9'))) and
((HFOBHAD = ‘2’) or (RHFO2 IN (‘2’,’3’,’4’,’5’,’6’)) or (RHFO2_YR = (current year – 1)
and RHFO2_MT lt current month) or (RHFO2_YR lt (current year – 1)) or (RHFO2T =
‘2’ and RHFO2N gt ‘52’) or (RHFO2T = ‘3’ and RHFO2N gt ‘12’) or (RHFO2T = '4' and
RHFO2N ge '2' and RHFO2 IN ('7','9')))
Universe-text
Sample adults 40+ who have NOT had a colonoscopy in the past 10 years,
sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home blood
stool/FIT test in the last year
Question Text
In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that
you be tested to look for problems in your colon or rectum?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto COLKIND1]
<2,R,D> [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 169 of 170
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.770_00.000
Variable Name
COLKIND1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLPROB1(e)='1'
Universe-text
Sample adults 40+ who have had particular tests recommended to look for problems in
the colon and who have NOT had a colonoscopy in the past 10 years, sigmoidoscopy in
the past 5 years, CT colonography in the past 5 years, or home blood stool/FIT test in
the last year and who had another type of test recommended
Question Text
Which tests to check for colon cancer did the doctor or other health professional
recommend to you? Possible tests include stool blood or fecal occult blood or FIT test;
Sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or other.
*Enter all that apply, separate with commas.
Answer Codes
1. Stool blood test/fecal occult blood/FIT test
2. Sigmoidoscopy
3. Colonoscopy
4. CT colonography/virtual colonoscopy
5. Other
Refused
Don't know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto genetic testing]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 170 of 170
2015 Q1 NHIS Instrument Spec Report
Section name: Genetic Testing
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.001_00.000
Variable Name
GCEVER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions refer to genetic COUNSELING for cancer risk. We will ask about
genetic TESTING for cancer risk in a few minutes. Genetic counseling involves a
discussion with a specially trained health care provider about your family history of
cancer and how likely you are to develop cancer. It may also include a discussion
about whether genetic testing is right for you.
Have you ever received genetic counseling for cancer risk?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic counseling-ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto GCMREAS]
<2,R,D> [goto GTPOSS1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.002_00.000
Variable Name
GCMREAS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GCEVER(e)='1'
Universe-text
Sample adults 18+ who have ever received genetic counseling
Question Text
What was the MAIN reason you had genetic counseling?
Answer Codes
1. Your doctor recommended it
2. You requested it
3. Family member suggested it
4. You heard or read about it in the news
5. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Main reason
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto GCBREAST]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 2 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.003_00.000
Variable Name
GCBREAST
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GCEVER(e)='1'
Universe-text
Sample adults 18+ who have ever received genetic counseling
Question Text
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for breast cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Counseling-breast cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GCOVRN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.004_00.000
Variable Name
GCOVRN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GCEVER(e)='1'
and SEX='2'
Universe-text
Female Sample adults 18+ who have ever received genetic counseling
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for ovarian cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Counseling-ovarian cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GCCOLON]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 4 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.005_00.000
Variable Name
GCCOLON
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GCEVER(e)='1'
Universe-text
Sample adults 18+ who have ever received genetic counseling
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for colon or rectal cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Counseling-colorectal cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GCANOTH]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.006_00.000
Variable Name
GCANOTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GCEVER(e)='1'
Universe-text
Sample adults 18+ who have ever received genetic counseling
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for another type of cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Counseling-another type
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto GCSPEC]
<2,R,D> [goto GTPOSS1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 6 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.007_00.000
Variable Name
GCSPEC
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (GCEVER(e)='1'
and GCANOTH(e)='1')
Universe-text
Sample adults 18+ who have ever received genetic counseling for another type of
cancer
Question Text
*Specify other cancer for which genetic counseling was received.
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
Counseling-specify
Fill Instructions
Special Instructions
Skip Instructions
[goto GTPOSS1]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.015_00.000
Variable Name
GTPOSS1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The following questions refer to genetic testing for cancer risk. That is, testing your
blood to see if you carry genes which may predict a greater chance of developing
cancer at some point in your life. This does NOT include tests to determine if you have
cancer now. Do NOT include self-testing kits administered at home.
Have you EVER DISCUSSED the possibility of getting a genetic test for cancer risk
with a doctor or other health professional?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Testing discuss
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto GTADVIS1]
<2,R,D> [goto GTGRISK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 8 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.025_00.000
Variable Name
GTADVIS1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GTPOSS1(e)='1'
Universe-text
Sample adults 18+ who have discussed the possibility of getting a genetic test with a
doctor or other health professional
Question Text
Did a doctor or other health professional ADVISE you to have such a test?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Advised to have test
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GTGRISK]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.030_00.000
Variable Name
GTGRISK
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER HAD a genetic test to determine if you are at greater risk of developing
cancer in the FUTURE?
*Read if necessary: This does not include any test to see whether you had cancer in
the PAST or have cancer NOW.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic test ever
Fill Instructions
Special Instructions
Skip Instructions
<1> if SEX=2 [goto GTBRE];
else [goto GTCOL]
<2,R,D> [goto GTCCLOM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 10 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.040_01.000
Variable Name
GTBRE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (SEX='2' and
GTGRISK(e)='1')
Universe-text
Female sample adults 18+ who have ever had a genetic test
Question Text
Please think about your MOST RECENT genetic test for cancer risk. Was it for breast
cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic test-breast cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GTOVA]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.040_02.000
Variable Name
GTOVA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (SEX='2' and
GTGRISK(e)='1')
Universe-text
Female sample adults 18+ who have ever had a genetic test
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for ovarian cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic test-ovarian cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GTCOL]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 12 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.040_03.000
Variable Name
GTCOL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GTGRISK(e)='1'
Universe-text
Sample adults 18+ who have ever had a genetic test
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for colon or rectal cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic test-colorectal cancer
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto GTOTH]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.040_04.000
Variable Name
GTOTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GTGRISK(e)='1'
Universe-text
Sample adults 18+ who have ever had a genetic test
Question Text
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for another type of cancer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Genetic test-another cancer
Fill Instructions
Special Instructions
Skip Instructions
<1> goto [GTRSKOTH]
<2,R,D> goto [GTRSK_MT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 14 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.044_00.000
Variable Name
GTRSKOTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (GTGRISK(e)='1'
and GTOTH(e)='1')
Universe-text
Sample adults 18+ who have had a genetic test for another type of cancer
Question Text
*Specify other test for genetic risk of cancer.
Answer Codes
Verbatim,R,D
Question Type
Verbatim
Field Pane Description
Genetic test-specify
Fill Instructions
Special Instructions
Skip Instructions
goto [GTRSK_MT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.050_01.000
Variable Name
GTRSK_MT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and GTGRISK(e)='1'
Universe-text
Sample adults 18+ who have had a genetic test for cancer
Question Text
1 of 2
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and time period format.
Answer Codes
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Genetic test-month
Fill Instructions
Special Instructions If GTRSK_MT=R store "R" in GTRSK_YR; If GTRSK_MT=96 store "96" in GTRSK_YR
Skip Instructions
<1-12,D> goto GTRSK_YR
store "R' in GTRSK_YR then [goto GTCCLOM]
<96> store "9996" in GTRSK_YR then [goto GTRSKN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 16 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.050_02.000
Variable Name
GTRSK_YR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (GTGRISK(e)='1'
and (01<=GTRSK_MT(e)<='12' or GTRSK_MT='99'))
Universe-text
Sample adults 18+ who gave a month for their genetic test date or who didn't know the
month
Question Text
2 of 2
*Enter year of genetic test.
Answer Codes
Allow 1880-2016,9996,R,D
Question Type
Integer
Field Pane Description
Genetic test-year
Fill Instructions
Special Instructions If GTRSK_MT=R store "R" in GTRSK_YR; If GTRSK_MT=96 store "96" in GTRSK_YR
Skip Instructions
[goto GTCCLOM]
elseif GTRSK_MT and GTRSK_YR = a future date [goto
ERR1_GTRSK_YR]
elseif GTRSK1_MT and GTRSK_YR = a date prior to birth date
[goto ERR2_GTRSK_YR]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.055_01.000
Variable Name
GTRSKN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (GTGRISK(e)='1'
and GTRSK_MT(e)='96')
Universe-text
Sample adults 18+ who requested the time period format at GTRSK_MT
Question Text
1 of 2
When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-94,95,R,D
Question Type
Integer
Field Pane Description
Genetic test-number
Fill Instructions
Special Instructions If GTRSKN =R,D store 'R,D" in GTRSKT
Skip Instructions
<1-95> [goto GTRSKT]
store 'R,D" in GTRSKT then [goto GTCCLOM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 18 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.055_02.000
Variable Name
GTRSKT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (GTGRISK(e)='1'
and ('01'<=GTRSKN(e)<='95'))
Universe-text
Sample adults 18+ who answered 1-95 for the number part of this 2-part question
Question Text
2 of 2
*Enter time period for time since genetic test.
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Genetic test-time period
Fill Instructions
Special Instructions If GTRSKN =R,D store 'R,D" in GTRSKT
Skip Instructions
<1-4,R,D> [goto GTCCLOM]
if (GTRSKN = number greater than person years old and GTRSKT=4) then
[goto ERR1_GTRSKT]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.080_00.000
Variable Name
GTCCLOM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+ who have had a genetic test for another type of cancer
Question Text
Compared to the average {fill1: man/woman} your age, would you say that you are
more likely to get colon or rectal cancer, less likely, or about as likely?
*Read if necessary.
For a colon or rectal cancer survivor, this means getting colon or rectal cancer again in
the future.
Answer Codes
1. More likely to get colon or rectal cancer
2. Less likely
3. About as likely
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Risk of cancer
Fill1: If SEX=1 fill "man"; else fill "woman"
Special Instructions
Skip Instructions
<1-3,R,D> [if SEX = 1, goto next section; else if SEX = 2, goto GTCBOM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 20 of 21
Module
31
Section Name
Genetic Testing
Part
Question ID
NAG.090_00.000
Variable Name
GTCBOM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults age 18+
Question Text
Compared to the average woman your age, would you say that you are more likely to
get breast cancer, less likely, or about as likely?
*Read if necessary.
For a breast cancer survivor, this means getting breast cancer again in the future.
Answer Codes
1. More likely to get breast cancer
2. Less likely
3. About as likely
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Risk of breast cancer
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 21
2015 Q1 NHIS Instrument Spec Report
Section name: Family History
Module
32
Section Name
Family History
Part
Question ID
NAH.010_00.000
Variable Name
FHFCAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
We would like to ask you a few questions about your family history of cancer. Did your
BIOLOGICAL FATHER EVER have cancer of any kind?
Answer Codes
1. Yes
2. No
3. Adopted or don't know biological father
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Father had cancer
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto FHFTYP_1]
<2,3,RF,DK> [goto FHMCAN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 1 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.020_01.000
Variable Name
FHFTYP_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHFCAN=1
Universe-text
Sample adults 18+ whose father ever had cancer
Question Text
What kind of cancer did your father have?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_1
Fill Instructions
Special Instructions Gray out answer categories 6, 18, and 29.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> goto FHFAGE1
<6,18,29> goto ERR_FHFTYP_1
Monday, August 25, 2014
Page 2 of 107
Hard Edits
ERR_FHFTYP_1
* Code 6 or 18 or 29 is unavailable for males.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 3 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.020_02.000
Variable Name
FHFTYP_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHFAGE1=1,2,
DK or (FHFAGE1=RF and FHFTYP_1 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a first kind of cancer or didn't
know how old father was when first diagnosed with that kind of cancer or else refused
to provide an age range and had not refused to give first kind of cancer
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_2
Fill Instructions
Monday, August 25, 2014
Page 4 of 107
Special Instructions Gray out answer categories 6, 18, and 29. Gray out whatever option was selected in
FHFTYP_1 to indicate that that option is now not available. Make sure that if this option
is selected it triggers the error message that this is an invalid option.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> if FHFTYP_2 = FHFTYP_1 goto ERR2_FHFTYP_2
else goto FHFAGE2
<96> goto FHMCAN
<6,18,29> goto ERR1_FHFTYP_2
Hard Edits
ERR1_FHFTYP_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHFTYP_2
* Cannot select pre-selected answer.
Default should go to FHFTYP_2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 5 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.020_03.000
Variable Name
FHFTYP_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHFAGE2=1,2,
DK or (FHFAGE2=RF and FHFTYP_2 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a second kind of cancer or
didn't know how old father was when first diagnosed with that kind of cancer or else
refused to provide an age range and had not refused to give a second type of cancer
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_3
Fill Instructions
Monday, August 25, 2014
Page 6 of 107
Special Instructions Gray out answer categories 6, 18, and 29. Gray out whatever option was selected in
FHFTYP_1 and FHFTYP_2 to indicate that those options were already chosen. Make
sure that if this option is selected it triggers the error message that this is an invalid
option.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> if FHFTYP_3 = FHFTYP_1 or FHFTYP_2
goto ERR2_FHFTYP_3
else goto FHFAGE3
<96> goto FHMCAN
<6,18,29> goto ERR1_FHFTYP_3
Hard Edits
ERR1_FHFTYP_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHFTYP_3
* Cannot select pre-selected answer.
Default should go to FHFTYP_3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 7 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.020_04.000
Variable Name
FHFTYP_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHFAGE3=1,2,
DK or (FHFAGE3=RF and FHFTYP_3 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a third kind of cancer or didn't
know how old father was when first diagnosed that kind of cancer or else refused to
provide an age range but had not refused to give a third kind of cancer
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
More than 3 kinds of cancer
Page 8 of 107
Fill Instructions
Special Instructions Do not allow an answer of "Don’t know" or "Refused".
Gray out answer categories 6, 18, and 29. Gray out whatever options were selected in
FHFTYP_1, FHFTYP_2 and FHFTYP_3 to indicate that those options were already
chosen. The only valid options for this question are 95 and 96.
Skip Instructions
<95,96> goto FHMCAN
<1-30> goto ERR_FHFTYP_4
Hard Edits
ERR_FHFTYP_4
* The only valid answers are '95' and '96' for this screen.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 9 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.030_01.000
Variable Name
FHFAGE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHFTYP_1=1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ who selected a first kind of cancer for father or refused to answer or
didn't know kind of cancer
Question Text
Was your biological father under 50 years of age when [Fill: FHFTYP_1] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Father's age_1
Fill: bladder cancer if FHFTYP_1 = 1
blood cancer if FHFTYP_1 = 2
bone cancer if FHFTYP_1 = 3
brain cancer if FHFTYP_1 = 4
breast cancer if FHFTYP_1 = 5
cervical cancer if FHFTYP_1 = 6
colon cancer if FHFTYP_1 = 7
esophageal cancer if FHFTYP_1 = 8
gallbladder cancer if FHFTYP_1 = 9
kidney cancer if FHFTYP_1 = 10
larynx-windpipe cancer if FHFTYP_1 = 11
leukemia if FHFTYP_1 = 12
liver cancer if FHFTYP_1 = 13
lung cancer if FHFTYP_1 = 14
lymphoma if FHFTYP_1 = 15
melanoma if FHFTYP_1 = 16
mouth/tongue/lip cancer if FHFTYP_1 = 17
ovarian cancer if FHFTYP_1 = 18
pancreatic cancer if FHFTYP_1 = 19
prostate cancer if FHFTYP_1 = 20
rectal cancer if FHFTYP_1 = 21
skin (non-melanoma) cancer if FHFTYP_1 = 22
skin (don't know what kind) cancer if FHFTYP_1 = 23
soft tissue (muscle or fat) cancer if FHFTYP_1 = 24
stomach cancer if FHFTYP_1 = 25
testicular cancer if FHFTYP_1 = 26
throat/pharynx cancer if FHFTYP_1 = 27
thyroid cancer if FHFTYP_1 = 28
uterine cancer if FHFTYP_1 = 29
other cancer if FHFTYP_1 = 30
this cancer if FHTYP_1 = Refused or Don't know
Monday, August 25, 2014
Page 10 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHFTYP_2
IF FHFTYP_1=RF [goto FHMCAN]
else if FHFTYP_1 NE RF [goto FHFTYP_2]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 11 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.030_02.000
Variable Name
FHFAGE2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHFTYP_2=1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ who selected a second kind of cancer for father or refused to
answer or didn't know kind of cancer
Question Text
Was your biological father under 50 years of age when [Fill: FHFTYP_2] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Father's age_2
Fill: bladder cancer if FHFTYP_2 = 1
blood cancer if FHFTYP_2 = 2
bone cancer if FHFTYP_2 = 3
brain cancer if FHFTYP_2 = 4
breast cancer if FHFTYP_2 = 5
cervical cancer if FHFTYP_2 = 6
colon cancer if FHFTYP_2 = 7
esophageal cancer if FHFTYP_2 = 8
gallbladder cancer if FHFTYP_2 = 9
kidney cancer if FHFTYP_2 = 10
larynx-windpipe cancer if FHFTYP_2 = 11
leukemia if FHFTYP_2 = 12
liver cancer if FHFTYP_2 = 13
lung cancer if FHFTYP_2 = 14
lymphoma if FHFTYP_2 = 15
melanoma if FHFTYP_2 = 16
mouth/tongue/lip cancer if FHFTYP_2 = 17
ovarian cancer if FHFTYP_2 = 18
pancreatic cancer if FHFTYP_2 = 19
prostate cancer if FHFTYP_2 = 20
rectal cancer if FHFTYP_2 = 21
skin (non-melanoma) cancer if FHFTYP_2 = 22
skin (don't know what kind) cancer if FHFTYP_2 = 23
soft tissue (muscle or fat) cancer if FHFTYP_2 = 24
stomach cancer if FHFTYP_2 = 25
testicular cancer if FHFTYP_2 = 26
throat/pharynx cancer if FHFTYP_2 = 27
thyroid cancer if FHFTYP_2 = 28
uterine cancer if FHFTYP_2 = 29
other cancer if FHFTYP_2 = 30
this cancer if FHFTYP_2 = Refused or Don't know
Monday, August 25, 2014
Page 12 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHFTYP_3
IF FHFTYP_2=RF [goto FHMCAN]
else if FHFTYP NE RF [goto FHFTYP_3]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 13 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.030_03.000
Variable Name
FHFAGE3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHFTYP_3=1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ who selected a third kind of cancer for father or refused to answer
or didn't know kind of cancer
Question Text
Was your biological father under 50 years of age when [Fill: FHFTYP_3] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Father's age_3
Fill: bladder cancer if FHFTYP_3 = 1
blood cancer if FHFTYP_3 = 2
bone cancer if FHFTYP_3 = 3
brain cancer if FHFTYP_3 = 4
breast cancer if FHFTYP_3 = 5
cervical cancer if FHFTYP_3 = 6
colon cancer if FHFTYP_3 = 7
esophageal cancer if FHFTYP_3 = 8
gallbladder cancer if FHFTYP_3 = 9
kidney cancer if FHFTYP_3 = 10
larynx-windpipe cancer if FHFTYP_3 = 11
leukemia if FHFTYP_3 = 12
liver cancer if FHFTYP_3 = 13
lung cancer if FHFTYP_3 = 14
lymphoma if FHFTYP_3 = 15
melanoma if FHFTYP_3 = 16
mouth/tongue/lip cancer if FHFTYP_3 = 17
ovarian cancer if FHFTYP_3 = 18
pancreatic cancer if FHFTYP_3 = 19
prostate cancer if FHFTYP_3 = 20
rectal cancer if FHFTYP_3 = 21
skin (non-melanoma) cancer if FHFTYP_3 = 22
skin (don't know what kind) cancer if FHFTYP_3 = 23
soft tissue (muscle or fat) cancer if FHFTYP_3 = 24
stomach cancer if FHFTYP_3 = 25
testicular cancer if FHFTYP_3 = 26
throat/pharynx cancer if FHFTYP_3 = 27
thyroid cancer if FHFTYP_3 = 28
uterine cancer if FHFTYP_3 = 29
other cancer if FHFTYP_3 = 30
this cancer if FHFTYP_3 = Refused or Don't know
Monday, August 25, 2014
Page 14 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHFTYP_4
IF FHFTYP_3=RF [goto FHMCAN]
else if FHFTYP_3 NE RF [goto FHFTYP_4]
Hard Edits
Soft Edits
AssocHelp
Module
32
Section Name
Family History
Part
Question ID
NAH.040_00.000
Variable Name
FHMCAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Did your BIOLOGICAL MOTHER EVER have cancer of any kind?
Answer Codes
1. Yes
2. No
3. Adopted or don't know biological mother
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Mother had cancer
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto FHMTYP_1]
<2,3,RF,DK> [goto FHBNUM]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 15 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.050_01.000
Variable Name
FHMTYP_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHMCAN=1
Universe-text
Sample adults 18+ whose mother ever had cancer
Question Text
What kind of cancer did your mother have?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_1
Fill Instructions
Special Instructions Gray out answer categories 20 and 26.
Skip Instructions
<1-19,21-25,27-30,RF,DK> goto FHMAGE1
<20,26> goto ERR_FHMTYP_1
Monday, August 25, 2014
Page 16 of 107
Hard Edits
ERR_FHMTYP_1
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 17 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.050_02.000
Variable Name
FHMTYP_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
(FHMAGE1=1,2,DK or (FHMAGE1=RF and FHMTYP_1 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a first kind of cancer or didn't
know how old mother was when first diagnosed with that kind of cancer or else refused
to provide an age range and had not refused to answer a first kind of cancer
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_2
Fill Instructions
Monday, August 25, 2014
Page 18 of 107
Special Instructions Gray out answer categories 20 and 26. Gray out whatever option was selected in
FHMTYP_1 to indicate that that option is now not available. Make sure that if this
option is selected it triggers the error message that this is an invalid option.
Skip Instructions
<1-19,21-25,27-30,RF,DK> if FHMTYP_2 = FHMTYP_1 goto ERR2_FHMTYP_2
else goto FHMAGE2
<96> goto FHBNUM
<20,26> goto ERR1_FHMTYP_2
Hard Edits
ERR1_FHMTYP_2
* Code 20 or 26 is unavailable for females.
ERR2_FHMTYP_2
* Cannot select pre-selected answer.
Default should go to FHMTYP_2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 19 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.050_03.000
Variable Name
FHMTYP_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
(FHMAGE2=1,2,DK or (FHMAGE2=RF and FHMTYP_2 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a second kind of cancer or
didn't know how old mother was when first diagnosed with that kind of cancer or else
refused to provide an age range and had not refused to answer a second kind of cancer
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_3
Page 20 of 107
Fill Instructions
Special Instructions Gray out answer categories 20 and 26. Gray out whatever option was selected in
FHMTYP_1 and FHMTYP_2 to indicate that those options were already chosen. Make
sure that if this option is selected it triggers the error message that this is an invalid
option.
Skip Instructions
<1-19,21-25,27-30,RF,DK> if FHMTYP_3 = FHMTYP_1 or FHMTYP_2 goto
ERR2_FHMTYP_3
else goto FHMAGE3
<96> goto FHBNUM
<20,26> goto ERR1_FHMTYP_3
Hard Edits
ERR_FHMTYP_3
* Code 20 or 26 is unavailable for females.
ERR2_FHMTYP_3
* Cannot select pre-selected answer.
Default should go to FHMTYP_3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 21 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.050_04.000
Variable Name
FHMTYP_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
(FHMAGE3=1,2,DK or (FHMAGE3=RF and FHMTYP_3 ne RF))
Universe-text
Sample adults 18+ who either provided an age range for a third kind of cancer or didn't
know how old mother was when first diagnosed with that kind of cancer or else refused
to provide an age range but had not refused to answer a third kind of cancer
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
More than 3 kinds of cancer
Page 22 of 107
Fill Instructions
Special Instructions Do not allow an answer of "Don't know" or "Refused".
Gray out answer categories 20 and 26. Gray out whatever options were selected in
FHMTYP_1, FHMTYP_2 and FHMTYP_3 to indicate that those options were already
chosen. The only valid options for this question are 95 and 96.
Skip Instructions
<95,96> goto FHBNUM
<1-30> ERR_FHMTYP_4
Hard Edits
ERR_FHMTYP_4
* The only valid answers are '95' and '96' for this screen.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 23 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.060_01.000
Variable Name
FHMAGE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHMTYP_1=119,21-25,27-30,RF,DK
Universe-text
Sample adults 18+ who selected a first kind of cancer for mother or refused to answer
or didn't know kind of cancer
Question Text
Was your biological mother under 50 years of age when [Fill: FHMTYP_1] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Mother's age_1
Fill: bladder cancer if FHMTYP_1 = 1
blood cancer if FHMTYP_1 = 2
bone cancer if FHMTYP_1 = 3
brain cancer if FHMTYP_1 = 4
breast cancer if FHMTYP_1 = 5
cervical cancer if FHMTYP_1 = 6
colon cancer ifFHMTYP_1 = 7
esophageal cancer if FHMTYP_1 = 8
gallbladder cancer if FHMTYP_1 = 9
kidney cancer if FHMTYP_1 = 10
larynx-windpipe cancer if FHMTYP_1 = 11
leukemia if FHMTYP_1 = 12
liver cancer if FHMTYP_1 = 13
lung cancer if FHMTYP_1 = 14
lymphoma if FHMTYP_1 = 15
melanoma if FHMTYP_1 = 16
mouth/tongue/lip cancer if FHMTYP_1 = 17
ovarian cancer if FHMTYP_1 = 18
pancreatic cancer if FHMTYP_1 = 19
prostate cancer if FHMTYP_1 = 20
rectal cancer if FHMTYP_1 = 21
skin (non-melanoma) cancer if FHMTYP_1 = 22
skin (don't know what kind) cancer if FHMTYP_1 = 23
soft tissue (muscle or fat) cancer if FHMTYP_1 = 24
stomach cancer if FHMTYP_1 = 25
testicular cancer if FHMTYP_1 = 26
throat/pharynx cancer if FHMTYP_1 = 27
thyroid cancer if FHMTYP_1 = 28
uterine cancer if FHMTYP_1 = 29
other cancer if FHMTYP_1 = 30
this cancer if FHMTYP_1 = Refused or Don't know
Monday, August 25, 2014
Page 24 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHMTYP_2
IF FHMTYP_1=RF goto FHBNUM
else if FHMTYP_1 NE RF goto FHMTYP_2
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 25 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.060_02.000
Variable Name
FHMAGE2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHMTYP_2 = 119,21-25,27-30,RF,DK
Universe-text
Sample adults 18+ who selected a second kind of cancer for mother or refused to
answer or didn't know kind of cancer
Question Text
Was your biological mother under 50 years of age when [Fill: FHMTYP_2] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Mother's age_2
Fill: bladder cancer if FHMTYP_2 = 1
blood cancer if FHMTYP_2 = 2
bone cancer if FHMTYP_2 = 3
brain cancer if FHMTYP_2 = 4
breast cancer if FHMTYP_2 = 5
cervical cancer if FHMTYP_2 = 6
colon cancer if FHMTYP_2 = 7
esophageal cancer if FHMTYP_2 = 8
gallbladder cancer if FHMTYP_2 = 9
kidney cancer if FHMTYP_2 = 10
larynx-windpipe cancer if FHMTYP_2 = 11
leukemia if FHMTYP_2 = 12
liver cancer if FHMTYP_2 = 13
lung cancer if FHMTYP_2 = 14
lymphoma if FHMTYP_2 = 15
melanoma if FHMTYP_2 = 16
mouth/tongue/lip cancer if FHMTYP_2 = 17
ovarian cancer if FHMTYP_2 = 18
pancreatic cancer if FHMTYP_2 = 19
prostate cancer if FHMTYP_2 = 20
rectal cancer if FHMTYP_2 = 21
skin (non-melanoma) cancer if FHMTYP_2 = 22
skin (don't know what kind) cancer if FHMTYP_2 = 23
soft tissue (muscle or fat) cancer if FHMTYP_2 = 24
stomach cancer if FHMTYP_2 = 25
testicular cancer if FHMTYP_2 = 26
throat/pharynx cancer if FHMTYP_2 = 27
thyroid cancer if FHMTYP_2 = 28
uterine cancer if FHMTYP_2 = 29
other cancer if FHMTYP_2 = 30
this cancer if FHMTYP_2 = Refused or Don't know
Monday, August 25, 2014
Page 26 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHMTYP_3
IF FHMTYP_2=RF goto FHBCAN
else if FHMTYP_2 NE RF goto FHMTYP_3
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 27 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.060_03.000
Variable Name
FHMAGE3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHMTYP_3 = 119,21-25,27-30,RF,DK
Universe-text
Sample adults 18+ who selected a third kind of cancer for mother or refused to answer
or didn't know kind of cancer
Question Text
Was your biological mother under 50 years of age when [Fill: FHMTYP_3] was first
diagnosed?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Mother's age_3
Fill: bladder cancer if FHMTYP_3 = 1
blood cancer if FHMTYP_3 = 2
bone cancer if FHMTYP_3 = 3
brain cancer if FHMTYP_3 = 4
breast cancer if FHMTYP_3 = 5
cervical cancer if FHMTYP_3 = 6
colon cancer if FHMTYP_3 = 7
esophageal cancer if FHMTYP_3 = 8
gallbladder cancer if FHMTYP_3 = 9
kidney cancer if FHMTYP_3 = 10
larynx-windpipe cancer if FHMTYP_3 = 11
leukemia if FHMTYP_3 = 12
liver cancer if FHMTYP_3 = 13
lung cancer if FHMTYP_3 = 14
lymphoma if FHMTYP_3 = 15
melanoma if FHMTYP_3 = 16
mouth/tongue/lip cancer if FHMTYP_3 = 17
ovarian cancer if FHMTYP_3 = 18
pancreatic cancer if FHMTYP_3 = 19
prostate cancer if FHMTYP_3 = 20
rectal cancer if FHMTYP_3 = 21
skin (non-melanoma) cancer if FHMTYP_3 = 22
skin (don't know what kind) cancer if FHMTYP_3 = 23
soft tissue (muscle or fat) cancer if FHMTYP_3 = 24
stomach cancer if FHMTYP_3 = 25
testicular cancer if FHMTYP_3 = 26
throat/pharynx cancer if FHMTYP_3 = 27
thyroid cancer if FHMTYP_3 = 28
uterine cancer if FHMTYP_3 = 29
other cancer if FHMTYP_3 = 30
this cancer if FHMTYP_3 = Refused or Don't know
Monday, August 25, 2014
Page 28 of 107
Special Instructions
Skip Instructions
<1,2,DK> goto FHMTYP_4
IF FHMTYP_3=RF goto FHBNUM
else if FHMTYP_3 NE RF goto FHMTYP_4
Hard Edits
Soft Edits
AssocHelp
Module
32
Section Name
Family History
Part
Question ID
NAH.070_00.000
Variable Name
FHBNUM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
FULL BROTHERS have the same biological mother and father as you. How many
FULL BROTHERS do you have? Please include any who are alive and those who may
have died.
*Enter '0' for none.
*Enter '21' for 21 or more brothers.
Answer Codes
Question Type
Integer
Field Pane Description
Number of brothers
Fill Instructions
Special Instructions
Skip Instructions
<0,RF,DK> [goto FHSNUM]
<1-21>[goto FHBCAN]
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 29 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.080_00.000
Variable Name
FHBCAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBNUM=1-21
Universe-text
Sample adults 18+ who have at least one full brother
Question Text
[Fill1: Did your BROTHER EVER have cancer of any kind?
*Enter '0' if brother has not had any kind of cancer.
*Enter '1' if brother has had cancer.]
[Fill2: How many of your BROTHERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Brother(s) with cancer
Fill1: if FHBNUM=1
Fill2: if FHBNUM 2-21
Special Instructions
Skip Instructions
<0,RF,DK> goto FHSNUM
<1-21> if FHBCAN GT FHBNUM
goto ERR_FHBCAN
else
goto FHBTYP_1
Hard Edits
ERR_FHBCAN
* Number is greater than number of brothers.
* Please correct.
Default should go to FHBCAN
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 30 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.090_01.000
Variable Name
FHBTYP_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBCAN 1-21
Universe-text
Sample adults 18+ whose brother(s) ever had cancer
Question Text
What kinds of cancer did your [Fill1: brother/Fill2: brothers] have?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Kind of cancer_1
Fill1: if FHBCAN=1
Fill2: if FHBCAN=2-21
Special Instructions if FHBCAN = '1'
store '1' in FHBMAN1
Monday, August 25, 2014
Page 31 of 107
Gray out answer categories 6, 18, 29.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> if FHBCAN = '1' goto FHBAGE1
else goto FHBMAN1
<6,18,29> goto ERR_FHBTYP_1
Hard Edits
ERR_FHBTYP_1
* Code 6 or 18 or 29 is unavailable for males.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 32 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.090_02.000
Variable Name
FHBTYP_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHBAGE1=021,DK or (FHBAGE1=RF and FHBTYP_1 ne RF))
Universe-text
Sample adults 18+ who provided age range for brother(s) diagnosed with the first kind
of cancer or didn't know how old brother(s) was/were when first diagnosed with that
kind of cancer or else refused to provide an age range and had not refused to answer
the first kind of cancer
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_2
Page 33 of 107
Fill Instructions
Special Instructions if FHBCAN = '1'
store '1' in FHBMAN2
Gray out answer categories 6, 18, 29. Gray out whatever option was selected in
FHBTYP_1 to indicate that that option is now not available. Make sure that if this
option is selected it triggers the error message that this is an invalid option.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> if FHBTYP_2 = FHBTYP_1 goto ERR2_FHBTYP_2
elseif FHBCAN = '1' goto FHBAGE2
else goto FHBMAN2
<96> goto FHSNUM
<6,18,29> goto ERR1_FHBTYP_2
Hard Edits
ERR1_FHBTYP_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHBTYP_2
* Cannot select pre-selected answer.
Default should go to FHBTYP_2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 34 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.090_03.000
Variable Name
FHBTYP_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHBAGE2=021,DK or (FHBAGE2=RF and FHBTYP_2 ne RF))
Universe-text
Sample adults 18+ who provided age range for brother(s) diagnosed with the second
kind of cancer or didn't know how old brother(s) was/were when first diagnosed with
that kind of cancer or else refused to provide an age range and had not refused to
answer the second kind of cancer
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_3
Page 35 of 107
Fill Instructions
Special Instructions if FHBCAN = '1'
store '1' in FHBMAN3
Gray out answer categories 6, 18, 29. Gray out whatever option was selected in
FHBTYP_1 and FHBTYP_2 to indicate that those options were already chosen. Make
sure that if this option is selected it triggers the error message that this is an invalid
option.
Skip Instructions
<1-5,7-17,19-28,30,RF,DK> if FHBTYP_3 = FHBTYP_1 or FHBTYP_2 goto
ERR2_FHBTYP_3
elseif FHBCAN = '1' goto FHBAGE3
else goto FHBMAN3
<96> goto FHSNUM
<6,18,29> goto ERR1_FHBTYP_3
Hard Edits
ERR1_FHBTYP_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHBTYP_3
* Cannot select pre-selected answer.
Default should go to FHBTYP_3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 36 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.090_04.000
Variable Name
FHBTYP_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHBAGE3=021,DK or (FHBAGE3=RF and FHBTYP_3 ne RF))
Universe-text
Sample adults 18+ who provided age range for brother(s) diagnosed with the third kind
of cancer or didn't know how old brother(s) was/were when first diagnosed with that
kind of cancer or else refused to provide an age range and had not refused to answer
the third kind of cancer
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
More than 3 kinds of cancer
Page 37 of 107
Fill Instructions
Special Instructions Do not allow an answer of "Don't know" or "Refused".
Gray out answer categories 6, 18, and 29. Gray out whatever options were selected in
FHBTYP_1, FHBTYP_2 and FHBTYP_3 to indicate that those options were already
chosen. The only valid options for this question are 95 and 96.
Skip Instructions
<95,96> goto FHSNUM
<1-30> goto ERR_FHBTYP_4
Hard Edits
ERR_FHBTYP_4
* The only valid answers are '95' and '96' for this screen.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 38 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.091_00.000
Variable Name
FHBMAN1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBTYP_1=1-5,717,19-28,30,RF,DK and FHBCAN=2-21
Universe-text
Sample adults 18+ who have brothers with a first kind of cancer
Question Text
How many brothers have had [Fill: FHBTYP_1]?
*Enter '21' for 21 or more brothers.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Brother(s)_cancer type 1
Fill: bladder cancer if FHBTYP_1 = 1
blood cancer if FHBTYP_1 = 2
bone cancer if FHBTYP_1 = 3
brain cancer if FHBTYP_1 = 4
breast cancer if FHBTYP_1 = 5
cervical cancer if FHBTYP_1 = 6
colon cancer if FHBTYP_1 = 7
esophageal cancer if FHBTYP_1 = 8
gallbladder cancer if FHBTYP_1 = 9
kidney cancer if FHBTYP_1 = 10
larynx-windpipe cancer if FHBTYP_1 = 11
leukemia if FHBTYP_1 = 12
liver cancer if FHBTYP_1 = 13
lung cancer if FHBTYP_1 = 14
lymphoma if FHBTYP_1 = 15
melanoma if FHBTYP_1 = 16
mouth/tongue/lip cancer if FHBTYP_1 = 17
ovarian cancer if FHBTYP_1 = 18
pancreatic cancer if FHBTYP_1 = 19
prostate cancer if FHBTYP_1 = 20
rectal cancer if FHBTYP_1 = 21
skin (non-melanoma) cancer if FHBTYP_1 = 22
skin (don't know what kind) cancer if FHBTYP_1 = 23
soft tissue (muscle or fat) cancer if FHBTYP_1 = 24
stomach cancer if FHBTYP_1 = 25
testicular cancer if FHBTYP_1 = 26
throat/pharynx cancer if FHBTYP_1 = 27
thyroid cancer if FHBTYP_1 = 28
uterine cancer if FHBTYP_1 = 29
other cancer if FHBTYP_1 = 30
this cancer if FHBTYP_1 = Refused or Don't know
Special Instructions
Skip Instructions
<1-21> if FHBMAN1 GT FHBCAN goto ERR_FHBMAN1
else goto FHBAGE1
Monday, August 25, 2014
Page 39 of 107
goto FHBAGE1
Hard Edits
ERR_FHBMAN1
* Number is greater than number of brothers with cancer.
* Please correct.
Default should go to FHBMAN1
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 40 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.092_00.000
Variable Name
FHBAGE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBTYP_1=1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ whose brother(s) had a first kind of cancer or refused or didn't know
name of first kind of cancer
Question Text
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_1] was first
diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3:
FHBTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age first cancer_brother(s)
Fill1: if FHBMAN1=1
Fill2: if FHBMAN1 GE 2 or FHBMAN1 = Refused or FHBMAN1 = Don't know
Fill3: bladder cancer if FHBTYP_1 = 1
blood cancer if FHBTYP_1 = 2
bone cancer if FHBTYP_1 = 3
brain cancer if FHBTYP_1 = 4
cervical cancer if FHBTYP_1 = 6
colon cancer if FHBTYP_1 = 7
esophageal cancer if FHBTYP_1 = 8
gallbladder cancer if FHBTYP_1 = 9
kidney cancer if FHBTYP_1 = 10
larynx-windpipe cancer if FHBTYP_1 = 11
leukemia if FHBTYP_1 = 12
liver cancer if FHBTYP_1 = 13
lung cancer if FHBTYP_1 = 14
lymphoma if FHBTYP_1 = 15
melanoma if FHBTYP_1 = 16
mouth/tongue/lip cancer if FHBTYP_1 = 17
pancreatic cancer if FHBTYP_1 = 19
prostate cancer if FHBTYP_1 = 20
rectal cancer if FHBTYP_1 = 21
skin (non-melanoma) cancer if FHBTYP_1 = 22
skin (don't know what kind) cancer if FHBTYP_1 = 23
soft tissue (muscle or fat) cancer if FHBTYP_1 = 24
stomach cancer if FHBTYP_1 = 25
Monday, August 25, 2014
Page 41 of 107
testicular cancer if FHBTYP_1 = 26
throat/pharynx cancer if FHBTYP_1 = 27
thyroid cancer if FHBTYP_1 = 28
uterine cancer if FHBTYP_1 = 29
other cancer if FHBTYP_1 =30
this cancer if FHBTYP_1 = Refused or Don't know
Special Instructions
Skip Instructions
<0-21> if FHBMAN1 NE 'Refused' and FHBMAN1 NE 'Don't know' and FHBAGE1 GT
FHBMAN1
goto ERR1_FHBAGE1
elseif (FHBMAN1 = 'Refused' or FHBMAN1 = 'Don't know') and FHBAGE1 GT
FHBCAN
goto ERR2_FHBAGE1
else
goto FHBTYP_2
goto FHBTYP_2
IF FHBTYP_1=RF goto FHSNUM
else if FHBTYP_1 NE RF goto FHBTYP_2
Hard Edits
ERR1_FHBAGE1
* Number is greater than number of brothers with this kind of cancer.
* Please correct.
Default should go to FHBAGE1
ERR2_FHBAGE1
* Number is greater than number of brothers with cancer.
* Please correct.
Default should go to FHBAGE1
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 42 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.093_00.000
Variable Name
FHBMAN2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBTYP_2 = 1-5,717,19-28,30,RF,DK and FHBCAN=2-21
Universe-text
Sample adults 18+ who have brothers with a second kind of cancer
Question Text
How many brothers have had [Fill: FHBTYP_2]?
*Enter '21' for 21 or more brothers.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Brother(s)_cancer type 2
Fill: bladder cancer if FHBTYP_2 = 1
blood cancer if FHBTYP_2 = 2
bone cancer if FHBTYP_2 = 3
brain cancer if FHBTYP_2 = 4
breast cancer if FHBTYP_2 = 5
cervical cancer if FHBTYP_2 = 6
colon cancer if FHBTYP_2 = 7
esophageal cancer if FHBTYP_2 = 8
gallbladder cancer if FHBTYP_2 = 9
kidney cancer if FHBTYP_2 = 10
larynx-windpipe cancer if FHBTYP_2 = 11
leukemia if FHBTYP_2 = 12
liver cancer if FHBTYP_2 = 13
lung cancer if FHBTYP_2 = 14
lymphoma if FHBTYP_2 = 15
melanoma if FHBTYP_2 = 16
mouth/tongue/lip cancer if FHBTYP_2 = 17
ovarian cancer if FHBTYP_2 = 18
pancreatic cancer if FHBTYP_2 = 19
prostate cancer if FHBTYP_2 = 20
rectal cancer if FHBTYP_2 = 21
skin (non-melanoma) cancer if FHBTYP_2 = 22
skin (don't know what kind) cancer if FHBTYP_2 = 23
soft tissue (muscle or fat) cancer if FHBTYP_2 = 24
stomach cancer if FHBTYP_2 = 25
testicular cancer if FHBTYP_2 = 26
throat/pharynx cancer if FHBTYP_2 = 27
thyroid cancer if FHBTYP_2 = 28
uterine cancer if FHBTYP_2 = 29
other cancer if FHBTYP_2 = 30
this cancer if FHBTYP_2 = Refused or Don’t know
Special Instructions
Skip Instructions
<1-21> if FHBMAN2 GT FHBCAN
goto ERR_FHBMAN2
Monday, August 25, 2014
Page 43 of 107
else
goto FHBAGE2
goto FHBAGE2
Hard Edits
ERR_FHBMAN2
*Number is greater than number of brothers with
cancer.
*Please correct.
Default should go to FHBMAN2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 44 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.094_00.000
Variable Name
FHBAGE2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBTYP_2 = 1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ whose brother(s) had a second kind of cancer or refused or didn't
know name of second kind of cancer
Question Text
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_2] was first
diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3:
FHBTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age second cancer_brother(s)
Fill1: if FHBMAN2=1
Fill2: if FHBMAN2 GE 2 or FHBMAN2 = Refused or FHBMAN2 = Don't konw
Fill3: bladder cancer if FHBTYP_2 = 1
blood cancer if FHBTYP_2 = 2
bone cancer if FHBTYP_2 = 3
brain cancer if FHBTYP_2 = 4
breast cancer if FHBTYP_2 = 5
cervical cancer if FHBTYP_2 = 6
colon cancer if FHBTYP_2 = 7
esophageal cancer if FHBTYP_2 = 8
gallbladder cancer if FHBTYP_2 = 9
kidney cancer if FHBTYP_2 = 10
larynx-windpipe cancer if FHBTYP_2 = 11
leukemia if FHBTYP_2 = 12
liver cancer if FHBTYP_2 = 13
lung cancer if FHBTYP_2 = 14
lymphoma if FHBTYP_2 = 15
melanoma if FHBTYP_2 = 16
mouth/tongue/lip cancer if FHBTYP_2 = 17
ovarian cancer if FHBTYP_2 = 18
pancreatic cancer if FHBTYP_2 = 19
prostate cancer if FHBTYP_2 = 20
rectal cancer if FHBTYP_2 = 21
skin (non-melanoma) cancer if FHBTYP_2 = 22
skin (don't know what kind) cancer if FHBTYP_2 = 23
Monday, August 25, 2014
Page 45 of 107
soft tissue (muscle or fat) cancer if FHBTYP_2 = 24
stomach cancer if FHBTYP_2 = 25
testicular cancer if FHBTYP_2 = 26
throat/pharynx cancer if FHBTYP_2 = 27
thyroid cancer if FHBTYP_2 = 28
uterine cancer if FHBTYP_2 = 29
other cancer if FHBTYP_2 = 30
this cancer if FHBTYP_2 = Refused or Don't know
Special Instructions
Skip Instructions
<0-21> if FHBMAN2 NE 'Refused' and FHBMAN2 ne 'Don't know' and FHBAGE2 GT
FHBMAN2
goto ERR1_FHBAGE2
elseif (FHBMAN2 = 'Refused' or FHBMAN2 = 'Don't know') and FHBAGE2 GT
FHBCAN
goto ERR2_FHBAGE2
else
goto FHBTYP_3
goto FHBTYP_3
and at FHBTYP_2 goto FHSNUM
and FHBTYP_2 NE goto FHBTYP_3
Hard Edits
ERR1_FHBAGE2
* Number is greater than number of brothers with this kind of cancer.
* Please correct.
Default should go to FHBAGE2
ERR2_FHBAGE2
* Number is greater than number of brothers with cancer.
* Please correct.
Default should go to FHBAGE2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 46 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.095_00.000
Variable Name
FHBMAN3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and and FHBTYP_3 =
1-5,7-17,19-28,30,RF,DK and FHBCAN=2-21
Universe-text
Sample adults 18+ who have brothers with a third kind of cancer
Question Text
How many brothers have had [Fill: FHBTYP_3]?
*Enter '21' for 21 or more brothers.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Brother(s)_cancer type 3
Fill: bladder cancer if FHBTYP_3 = 1
blood cancer if FHBTYP_3 = 2
bone cancer if FHBTYP_3 = 3
brain cancer if FHBTYP_3 = 4
breast cancer if FHBTYP_3 = 5
cervical cancer if FHBTYP_3 = 6
colon cancer if FHBTYP_3 = 7
esophageal cancer if FHBTYP_3 = 8
gallbladder cancer if FHBTYP_3 = 9
kidney cancer if FHBTYP_3 = 10
larynx-windpipe cancer if FHBTYP_3 = 11
leukemia if FHBTYP_3 = 12
liver cancer if FHBTYP_3 = 13
lung cancer if FHBTYP_3 = 14
lymphoma if FHBTYP_3 = 15
melanoma if FHBTYP_3 = 16
mouth/tongue/lip cancer if FHBTYP_3 = 17
ovarian cancer if FHBTYP_3 = 18
pancreatic cancer if FHBTYP_3 = 19
prostate cancer if FHBTYP_3 = 20
rectal cancer if FHBTYP_3 = 21
skin (non-melanoma) cancer if FHBTYP_3 = 22
skin (don't know what kind) cancer if FHBTYP_3 = 23
soft tissue (muscle or fat) cancer if FHBTYP_3 = 24
stomach cancer if FHBTYP_3 = 25
testicular cancer if FHBTYP_3 = 26
throat/pharynx cancer if FHBTYP_3 = 27
thyroid cancer if FHBTYP_3 = 28
uterine cancer if FHBTYP_3 = 29
other cancer if FHBTYP_3 = 30
this cancer if FHBTYP_3 = Refused or Don't know
Special Instructions
Skip Instructions
<1-21> if FHBMAN3 GT FHBCAN
goto ERR_FHBMAN3
Monday, August 25, 2014
Page 47 of 107
else
goto FHBAGE3
goto FHBAGE3
Hard Edits
ERR_FHBMAN3
* Number is greater than number of brothers with cancer.
* Please correct.
Default should go to FHBMAN3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 48 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.096_00.000
Variable Name
FHBAGE3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHBTYP_3 = 1-5,717,19-28,30,RF,DK
Universe-text
Sample adults 18+ whose brother(s) had a third kind of cancer or refused or didn't
know name of third kind of cancer
Question Text
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_3] was first
diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3:
FHBTYP_3] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age third cancer_brother(s)
Fill1: if FHBMAN3=1
Fill2: if FHBMAN3 GE 2 or FHBMAN3 = Refused or FHBMAN3 = Don't know
Fill3: bladder cancer if FHBTYP_3 = 1
blood cancer if FHBTYP_3 = 2
bone cancer if FHBTYP_3 = 3
brain cancer if FHBTYP_3 = 4
breast cancer if FHBTYP_3 = 5
cervical cancer if FHBTYP_3 = 6
colon cancer if FHBTYP_3 = 7
esophageal cancer if FHBTYP_3 = 8
gallbladder cancer if FHBTYP_3 = 9
kidney cancer if FHBTYP_3 = 10
larynx-windpipe cancer if FHBTYP_3 = 11
leukemia if FHBTYP_3 = 12
liver cancer if FHBTYP_3 = 13
lung cancer if FHBTYP_3 = 14
lymphoma if FHBTYP_3 = 15
melanoma if FHBTYP_3 = 16
mouth/tongue/lip cancer if FHBTYP_3 = 17
ovarian cancer if FHBTYP_3 = 18
pancreatic cancer if FHBTYP_3 = 19
prostate cancer if FHBTYP_3 = 20
rectal cancer if FHBTYP_3 = 21
skin (non-melanoma) cancer if FHBTYP_3 = 22
skin (don't know what kind) cancer if FHBTYP_3 = 23
Monday, August 25, 2014
Page 49 of 107
soft tissue (muscle or fat) cancer if FHBTYP_3 = 24
stomach cancer if FHBTYP_3 = 25
testicular cancer if FHBTYP_3 = 26
throat/pharynx cancer if FHBTYP_3 = 27
thyroid cancer if FHBTYP_3 = 28
uterine cancer if FHBTYP_3 = 29
other cancer if FHBTYP_3 = 30
this cancer if FHBTYP_3 = Refused or Don't know
Special Instructions
Skip Instructions
<0-21> if FHBMAN3 NE 'Refused' and FHBMAN3 NE 'Don't know' and FHBAGE3 GT
FHBMAN3
goto ERR1_FHBAGE3
elseif (FHBMAN3 = 'Refused' or FHBMAN3 = 'Don't know') and FHBAGE3 GT
FHBCAN
goto ERR2_FHBAGE3
else
goto FHBTYP_4
goto FHBTYP_4
and at FHBTYP_3 goto FHSNUM
and FHBTYP_3 NE goto FHBTYP_4
Hard Edits
ERR1_FHBAGE3
* Number is greater than number of brothers with this kind of cancer.
* Please correct.
Default should go to FHBAGE3
ERR2_FHBAGE3
* Number is greater than number of brothers with cancer.
* Please correct.
Default should go to FHBAGE3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 50 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.100_00.000
Variable Name
FHSNUM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
FULL SISTERS have the same biological mother and father as you. How many FULL
SISTERS do you have? Please include any who are alive and those who may have
died.
*Enter '0' for none.
*Enter '21' for 21 or more sisters.
Answer Codes
Question Type
Integer
Field Pane Description
Number of sisters
Fill Instructions
Special Instructions
Skip Instructions
<0,RF,DK> goto FHNNUM
<1-21> goto FHSCAN
Hard Edits
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 51 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.110_00.000
Variable Name
FHSCAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSNUM=1-21
Universe-text
Sample adults 18+ who have at least one full sister
Question Text
[Fill1: Did your SISTER EVER have cancer of any kind?
*Enter '0' if sister has not had any kind of cancer.
*Enter '1' if sister has had cancer.]
[Fill2: How many of your SISTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Sister(s) with cancer
Fill1: if FHSNUM=1
Fill2: if FHSNUM 2-21
Special Instructions
Skip Instructions
<0,RF,DK> goto FHNNUM
<1-21> if FHSCAN gt FHSNUM
goto ERR_FHSCAN
else
goto FHSTYP_1
Hard Edits
ERR_FHSCAN
* Number is greater than number of sisters.
* Please correct.
Default should go to FHSCAN
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 52 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.120_01.000
Variable Name
FHSTYP_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSCAN=1-21
Universe-text
Sample adults 18+ whose sister(s) ever had cancer
Question Text
What kind of cancer did your [Fill1: sister/Fill2: sisters] have?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Kind of cancer_1
Fill1: if FHSCAN=1
Fill2: if FHSCAN=2-21
Special Instructions if FHSCAN = 1
store '1' in FHSMAN1
Monday, August 25, 2014
Page 53 of 107
Gray out answer categories 20 and 26
Skip Instructions
<1-19,21-25,27-30,RF,DK> if FHSCAN = '1'
goto FHSAGE1
else
goto FHSMAN1
<20,26> goto ERR_FHSTYP_1
Hard Edits
ERR_FHSTYP_1
*Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 54 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.120_02.000
Variable Name
FHSTYP_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHSAGE1=021,DK or (FHSAGE1=RF and FHSTYP_1 ne RF))
Universe-text
Sample adults 18+ who provided age range for sister(s) diagnosed with the first kind of
cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of
cancer or else refused to provide an age range and had not refused to answer the first
kind of cancer
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_2
Page 55 of 107
Fill Instructions
Special Instructions if FHSCAN = 1
store '1' in FHSMAN2
Gray out answer categories 20 and 26. Gray out whatever option was selected in
FHSTYP_1 to indicate that that option is now not available. Make sure that if this
option is selected it triggers the error message that this is an invalid option.
Skip Instructions
<1-19,21-25,27-30,RF,DK> if FHSTYP_2 = FHSTYP_1
goto ERR2_FHSTYP_2
elseif FHSCAN = '1'
goto FHSAGE2
else
goto FHSMAN2
<96> goto FHNNUM
<20,26> goto ERR1_FHSTYP_2
Hard Edits
ERR1_FHSTYP_2
*Code 20 or 26 is unavailable for females.
ERR2_FHSTYP_2
* Cannot select pre-selected answer.
Default should go to FHSTYP_2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 56 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.120_03.000
Variable Name
FHSTYP_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHSAGE2=021,DK or (FHSAGE2=RF and FHSTYP_2 ne RF))
Universe-text
Sample adults 18+ who provided age range for sister(s) diagnosed with the second
kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that
kind of cancer or else refused to provide an age range and had not refused to answer
the second kind of cancer
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
Kind of cancer_3
Page 57 of 107
Fill Instructions
Special Instructions if FHSCAN = 1
store '1' in FHSMAN3
Gray out answer categories 20 and 26. Gray out whatever option was selected in
FHSTYP_1 and FHSTYP_2 to indicate that those option were already chosen. Make
sure that if this option is selected it triggers the error message that this is an invalid
option.
Skip Instructions
<1-19,21-25,27-30,RF,DK> if FHSTYP_2 = FHSTYP_1 or FHSTYP_2
goto ERR2_FHSTYP_3
elseif FHSCAN = '1'
goto FHSAGE3
else
goto FHSMAN3
<96> goto FHNNUM
<20,26> goto ERR1_FHSTYP_3
Hard Edits
ERR1_FHSTYP_3
*Code 20 or 26 is unavailable for females.
ERR2_FHSTYP_3
* Cannot select pre-selected answer.
Default should be FHSTYP_3
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 58 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.120_04.000
Variable Name
FHSTYP_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (FHSAGE3=021,DK or (FHSAGE3=RF and FHSTYP_3 ne RF))
Universe-text
Sample adults 18+ who provided age range for sister(s) diagnosed with the third kind of
cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of
cancer or else refused to provide an age range and had not refused to answer the third
kind of cancer
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma)
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat)
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Monday, August 25, 2014
More than 3 kinds of cancer
Page 59 of 107
Fill Instructions
Special Instructions Do not allow an answer of "Refused" or "Don't know".
Gray out answer categories 20 and 26. Gray out whatever options were selected in
FHSTYP_1, FHSTYP_2 and FHSTYP_3 to indicate that those options were already
chosen. The only valid options for this question are 95 and 96.
Skip Instructions
<95,96> goto FHNNUM
<1-30> goto ERR_FHSTYP_4
Hard Edits
ERR_FHSTYP_4
* The only valid answers are '95' and '96' for this screen.
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 60 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.121_00.000
Variable Name
FHSMAN1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSTYP_1=119,21-25,27-30,RF,DK and FHSCAN=2-21
Universe-text
Sample adults 18+ who have sisters with a first kind of cancer
Question Text
How many sisters have had [Fill: FHSTYP_1]?
* Enter '21' for 21 or more sisters.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Sister(s)_cancer type 1
Fill: bladder cancer if FHSTYP_1 = 1
blood cancer if FHSTYP_1 = 2
bone cancer if FHSTYP_1 = 3
brain cancer if FHSTYP_1 = 4
breast cancer if FHSTYP_1 = 5
cervical cancer if FHSTYP_1 = 6
colon cancer if FHSTYP_1 = 7
esophageal cancer if FHSTYP_1 = 8
gallbladder cancer if FHSTYP_1 = 9
kidney cancer if FHSTYP_1 = 10
larynx-windpipe cancer if FHSTYP_1 = 11
leukemia if FHSTYP_1 = 12
liver cancer if FHSTYP_1 = 13
lung cancer if FHSTYP_1 = 14
lymphoma if FHSTYP_1 = 15
melanoma if FHSTYP_1 = 16
mouth/tongue/lip cancer if FHSTYP_1 = 17
ovarian cancer if FHSTYP_1 = 18
pancreatic cancer if FHSTYP_1 = 19
prostate cancer if FHSTYP_1 = 20
rectal cancer if FHSTYP_1 = 21
skin (non-melanoma) cancer if FHSTYP_1 = 22
skin (don't know what kind) cancer if FHSTYP_1 = 23
soft tissue (muscle or fat) cancer if FHSTYP_1 = 24
stomach cancer if FHSTYP_1 = 25
testicular cancer if FHSTYP_1 = 26
throat/pharynx cancer if FHSTYP_1 = 27
thyroid cancer if FHSTYP_1 = 28
uterine cancer if FHSTYP_1 = 29
other cancer if FHSTYP_1 = 30
this cancer if FHSTYP_1 = Refused or Don't know
Special Instructions If FHSCAN eq <1> store '1' in FHSMAN1
Skip Instructions
<1-21> if FHSMAN1 GT FHSCAN
goto ERR_FHSMAN1
Monday, August 25, 2014
Page 61 of 107
else
goto FHSAGE1
goto FHSAGE1
Hard Edits
ERR_FHSMAN1
* Number is greater than number of sisters with cancer.
* Please correct.
Default should be FHSMAN1
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 62 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.122_00.000
Variable Name
FHSAGE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSTYP_1 = 119,21-25,27-30,RF,DK>
Universe-text
Sample adults 18+ whose sister(s) had a first kind of cancer or refused or didn't know
name of first kind of cancer
Question Text
[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_1] was first
diagnosed?
* Enter '0' if sister was 50 or over.
* Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_1]
was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age first cancer_sister(s)
Fill1: if FHSMAN1=1
Fill2: if FHSMAN1 GE 2 or FHSMAN1 = Refused or FHSMAN1 = Don't know
Fill3: bladder cancer if FHSTYP_1 = 1
blood cancer if FHSTYP_1 = 2
bone cancer if FHSTYP_1 = 3
brain cancer if FHSTYP_1 = 4
breast cancer if FHSTYP_1 = 5
cervical cancer if FHSTYP_1 = 6
colon cancer if FHSTYP_1 = 7
esophageal cancer if FHSTYP_1 = 8
gallbladder cancer if FHSTYP_1 = 9
kidney cancer if FHSTYP_1 = 10
larynx-windpipe cancer if FHSTYP_1 = 11
leukemia if FHSTYP_1 = 12
liver cancer if FHSTYP_1 = 13
lung cancer if FHSTYP_1 = 14
lymphoma if FHSTYP_1 = 15
melanoma if FHSTYP_1 = 16
mouth/tongue/lip cancer if FHSTYP_1 = 17
ovarian cancer if FHSTYP_1 = 18
pancreatic cancer if FHSTYP_1 = 19
prostate cancer if FHSTYP_1 = 20
rectal cancer if FHSTYP_1 = 21
skin (non-melanoma) cancer if FHSTYP_1 = 22
skin (don't know what kind) cancer if FHSTYP_1 = 23
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Page 63 of 107
soft tissue (muscle or fat) cancer if FHSTYP_1 = 24
stomach cancer if FHSTYP_1 = 25
testicular cancer if FHSTYP_1 = 26
throat/pharynx cancer if FHSTYP_1 = 27
thyroid cancer if FHSTYP_1 = 28
uterine cancer if FHSTYP_1 = 29
other cancer if FHSTYP_1 = 30
this cancer if FHSTYP_1 = Refused or Don't know
Special Instructions
Skip Instructions
<0-21> if FHSMAN1 NE 'Refused' and FHSMAN1 NE 'Don’t know' and FHSAGE1 GT
FHSMAN1
goto ERR1_FHSAGE1
elseif (FHSMAN1 = 'Refused' or FHSMAN1 = 'Don't know') and FHSAGE1 GT
FHSCAN
goto ERR2_FHSAGE1
else
goto FHSTYP_2
goto FHSTYP_2
and at FHSTYP_1 goto FHNNUM
and FHSTYP_1 NE goto FHSTYP_2
Hard Edits
ERR1_FHSAGE1
* Number is greater than number of sisters with this kind of cancer.
* Please correct.
Default should go to FHSAGE1
ERR2_FHSAGE1
* Number is greater than number of sisters with cancer.
* Please correct.
Default should go to FHSAGE1
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 64 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.123_00.000
Variable Name
FHSMAN2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSTYP_2 = 119,21-25,27-30,RF,DK and FHSCAN=2-21
Universe-text
Sample adults 18+ who have sisters with a second kind of cancer
Question Text
How many sisters have had [Fill: FHSTYP_2]?
* Enter '21' for 21 or more sisters.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Sister(s)_cancer type 2
Fill1: bladder cancer if FHSTYP_2 = 1
blood cancer if FHSTYP_2 = 2
bone cancer if FHSTYP_2 = 3
brain cancer if FHSTYP_2 = 4
breast cancer if FHSTYP_2 = 5
cervical cancer if FHSTYP_2 = 6
colon cancer if FHSTYP_2 = 7
esophageal cancer if FHSTYP_2 = 8
gallbladder cancer if FHSTYP_2 = 9
kidney cancer if FHSTYP_2 = 10
larynx-windpipe cancer if FHSTYP_2 = 11
leukemia if FHSTYP_2 = 12
liver cancer if FHSTYP_2 = 13
lung cancer if FHSTYP_2 = 14
lymphoma if FHSTYP_2 = 15
melanoma if FHSTYP_2 = 16
mouth/tongue/lip cancer if FHSTYP_2 = 17
ovarian cancer if FHSTYP_2 = 18
pancreatic cancer if FHSTYP_2 = 19
prostate cancer if FHSTYP_2 = 20
rectal cancer if FHSTYP_2 = 21
skin (non-melanoma) cancer if FHSTYP_2 = 22
skin (don't know what kind) cancer if FHSTYP_2 = 23
soft tissue (muscle or fat) cancer if FHSTYP_2 = 24
stomach cancer if FHSTYP_2 = 25
testicular cancer if FHSTYP_2 = 26
throat/pharynx cancer if FHSTYP_2 = 27
thyroid cancer if FHSTYP_2 = 28
uterine cancer if FHSTYP_2 = 29
other cancer if FHSTYP_2 = 30
this cancer if FHSTYP_2 = Refused or Don't kow
Special Instructions
Skip Instructions
<1-21> if FHSMAN2 GT FHSCAN
goto ERR_FHSMAN2
Monday, August 25, 2014
Page 65 of 107
else
goto FHSAGE2
goto FHSAGE2
Hard Edits
ERR_FHSMAN2
* Number is greater than number of sisters with cancer.
* Please correct.
Default should be FHSMAN2
Soft Edits
AssocHelp
Monday, August 25, 2014
Page 66 of 107
Module
32
Section Name
Family History
Part
Question ID
NAH.124_00.000
Variable Name
FHSAGE2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and FHSTYP_2 = 119,21-25,27-30,RF,DK
Universe-text
Sample adults 18+ whose sister(s) had a second kind of cancer or refused or didn't
know name of second kind of cancer
Question Text
[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_2] was first
diagnosed?
* Enter '0' if sister was 50 or over.
* Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_2]
was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age second cancer_sister(s)
Fill1: if FHSMAN2=1
Fill2: if FHSMAN2 GE 2 or FHSMAN2 = Refused or FHSMAN2 = Don't know
Fill3: bladder cancer if FHSTYP_2 = 1
blood cancer if FHSTYP_2 = 2
bone cancer if FHSTYP_2 = 3
brain cancer if FHSTYP_2 = 4
breast cancer if FHSTYP_2 = 5
cervical cancer if FHSTYP_2 = 6
colon cancer if FHSTYP_2 = 7
esophageal cancer if FHSTYP_2 = 8
gallbladder cancer if FHSTYP_2 = 9
kidney cancer if FHSTYP_2 = 10
larynx-windpipe cancer if FHSTYP_2 = 11
leukemia if FHSTYP_2 = 12
liver cancer if FHSTYP_2 = 13
lung cancer if FHSTYP_2 = 14
lymphoma if FHSTYP_2 = 15
melanoma if FHSTYP_2 = 16
mouth/tongue/lip cancer if FHSTYP_2 = 17
ovarian cancer if FHSTYP_2 = 18
pancreatic cancer if FHSTYP_2 = 19
prostate cancer if FHSTYP_2 = 20
rectal cancer if FHSTYP_2 = 21
skin (non-melanoma) cancer if FHSTYP_2 = 22
skin (don't know what kind) cancer if FHSTYP_2 = 23
Monday, August 25, 2014
Page 67 of 107
soft tissue (muscle or fat) cancer if FHSTYP_2 = 24
stomach cancer if FHSTYP_2 = 25
testicular cancer if FHSTYP_2 = 26
throat/pharynx cancer if FHSTYP_2 = 27
thyroid cancer if FHSTYP_2 = 28
uterine cancer if FHSTYP_2 = 29
other cancer if FHSTYP_2 = 30
this cancer if FHSTYP_2 = Refused or Don't know
Special Instructions
Skip Instructions
<0-21> if FHSMAN2 NE 'Refused' and FHSMAN2 NE 'Don’t know' and FHSAGE2 GT
FHSMAN2
goto ERR1_FHSAGE2
elseif (FHSMAN2 = 'Refused' or FHSMAN2 = 'Don't know') and FHSAGE2 GT
FHSCAN
goto ERR2_FHSAGE2
else
goto FHSTYP_3
goto FHSTYP_3
and at FHSTYP_2 goto FHNNUM